The hopes of people with mild Alzheimer’s disease have been dashed again by the agency that appraises treatments for use by the NHS in England and Wales, which has reaffirmed its original decision to deny them treatment with dementia drugs. The National Institute for Health and Clinical Excellence (NICE) has issued amended guidance but still asserts that the drugs would not be cost effective for the mild stages of the disease. The original guidance from NICE was challenged by Eisai, the UK licence holder for donepezil (Aricept), one of the class of acetylcholinesterase inhibitors affected. The Court of Appeal ordered NICE to hand over a fully executable form of its economic model for determining the drugs’ cost effectiveness, and Eisai and the Alzheimer’s Society made further representations that highlighted flaws in the model.