Nearly 100,000 patients with Alzheimer's a year will be refused drugs that could delay the onset of the disease, the Court of Appeal has heard.
The manufacturer of one drug - Aricept - has been fighting a decision to restrict access to patients in the later stages of the disease.
NHS drugs advisers said the therapy along with others in its class are not cost effective for early Alzheimer's.
The decision was upheld by the High Court earlier last year.
Drugs company Eisai brought the case to the High Court with support from fellow drugs firms Pfizer and Shire, which manufactures other drugs affected by the NHS ruling, and the Alzheimer's Society.
The legal debate is about whether the National Institute for Health and Clinical Excellence (NICE) followed a fair and transparent process in reaching the decision.
David Pannick QC, representing pharmaceutical company Eisai, told a panel of three appeal judges that the latest guidance ruling by NICE will have "a very substantial effect upon the availability and the potential duration of treatment" with the drugs.
He said: "The evidence suggest that, when the guidance takes full effect annually 96,600 patients with mild Alzheimer's disease will be refused treatment."
NICE guidance in 2001 recommended the drugs - which can make it easier to carry out everyday tasks - should be used as standard.
But advice published in November 2006, stated that the drugs should only be prescribed to people with moderate-stage disease.
NICE said the drugs, which cost about £2.50 a day, did not make enough of a difference to recommend them for all patients and were not good value for money.
The appeal hearing is expected to be completed by the end of Tuesday, although a judgment will be reserved until next month.
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