The French Ministry of Health and Welfare announced that they would take out medicines for Alzheimer’s treatment from health insurance.
On June 1st, 2018, the French Ministry of Health and Welfare ( the Ministry of Social Issues and Health ) announced that they would take out medicines for Alzheimer’s treatment from health insurance.
The contents are that the medicines ( Donepezil, Galantamine, Rivastigmine, and Memantine ) that are used for Alzheimer’s disease at present, will be taken out covering health insurance from Aug. 1. The targeted medicines are used to reduce the progress of dementia patients out of Alzheimer’s disease, and are used in Japan widely. In Japan, those medicines are covered by health insurance and people who need those can get by paying 10 ~ 30% by own expenses.
In France, there is a public organization called High Insurance Mechanism ( in French, HAS, Haute Autorite de Sante ) and they evaluate the medicines covered by health insurance or clinical effects of medical technology.
Even though medicines that are recognized to cover health insurance, later in case that the expected effectiveness cannot be reached, they recommend to take out the cover of insurance.
In October 2016, HAS announced the results of study of usefulness of curative medicine for Alzheimer’s disease.
As the results of studying researches announced in the world so far, they pointed out the proofs of delaying putting institutions by using medicines or of restraining in advancing in security are not enough and further more you cannot neglect adverse events such as digestive systems or circulatory systems.
That is why they recommend that it is not adequate that to cover those medicines with health insurance.
By those indications and recommendations, French Ministry of Health and Welfare decided not to cover health insurance of Alzheimer’s treating medicines.
At present in Japan, package inserts of the drugs used as Alzheimer’s medicines contain disclaimers such as “there are as yet no results proving this drug arrests worsening of the clinical condition itself in Alzheimer’s dementia“.
An example of Donepezil : http://www.info.pmda.go.jp/downfiles/ph/PDF/480235_1190012F1239_1_10.pdf
The current drugs are not confirmed to have positive effects to delay the progression of Alzheimer’s disease itself, but expected to help patient’s deteriorated nerve cell’s activities to temporarily relieve decline of memory or other functions.
Actually, earlier clinical trials showed administration to right person at right time can temporarily control drop of scores on cognitive function tests.
However, the real purpose for taking the medicines are not getting better scores, but enjoying higher quality of life, living independently as long as possible to avoid admission to a care home or too much burden on caregivers.
Having studied earlier researches to find if the medicines had positive effects on those essential purposes, HAS drew a conclusion that current evidenced was insufficient.
The reason that French Ministry of Health and Welfare let to a conclusion this time is that they protect the health of citizens and promotes the integrated care of patients. Furthermore, they raise the following important examples for counter moves for dementia.
1) Strengthen the role of family doctors : To examine the dementia patients and to secure the time for caring the quality of lives and their homes.
2) Reduction of the burden of care givers : To support to the caregivers of dementia patients and expansion of respite care facilities.
3) Enhancement of Alzheimer’s special teams : Set up a special team in the country which corresponds when the dementia patients get sick.
The decision of this time has done to put resources ( drug costs etc. ) currently used for curative medicine to give priority on counter measure parts.
Furthermore, since the basic method of treatment of Alzheimer’s disease has not found yet, the investments to the study of development of treatment technique will be kept doing from now on.
It is not clear that this applies to the Japanese situations. But, according to Mr. Yasuyuki Okumura ( Tokyo Metropolitan Institute of Medical Science, a principal researcher ) who researched the present situation of prescription of antidementia medicine, the amount of money in Japan for using dementia medicine such as Alzheimer’s disease is more than 150 billion yen and prescription for very elderly people ( 85 years old and above ) is almost half, it is pointed out that the prescription for very elderly people is not investigated in effectiveness and safety fully and it is questionable to prescribe carefully considering adverse events. ( According to Mr. Okumura )
Regarding the dementia such as Alzheimer’s disease, the development of medicine has a rough passage like the basic development of curative medicine failed on after another. On the other hand, it becomes cleat that the living environment of dementia patients improves or the dealing with them by surrounding people, the quality of life improves and the period of being independent has expanded. The countermeasure of dementia changes from past idea of “ alone by medicine “ to the environment total of dementia patients should be changed worldwide. The decision of French of this time may be manifestation of those trends.
