The vertiginous rise in mental health costs predicted in a King's Fund report this week should trigger debate about which drugs are approved for use.

The driver of these costs is dementia, and there is little in the pharmaceutical armoury to alleviate its onset.

The National Institute for Health and Clinical Excellence is focused on assessing whether a particular treatment offers the NHS value for money. In one of its more controversial decisions, it ruled that prescribing Aricept for mild dementia was not cost-effective.

As one of the King's Fund's authors stresses in this week's HSJ, there are grounds for looking at the impact of dementia drugs beyond the usual confines of patient benefit and NHS budget.

The effects of dementia ripple out to affect spouses, children and others as they battle to support the sufferer. Direct and indirect care costs have an economic impact which the present NICE guidelines fail to take into account.

It is time the government instructed NICE to provide a more rounded assessment of the costs and benefits of treatments - as well as keeping the pressure on drugs companies over pricing, of course.

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