Cheaper macular degeneration drug could save NHS millions

Avastin, a drug that treats neovascular age-related macular degeneration, could save the NHS millions

Published: 16 June 2019

Neovascular age-related macular degeneration

Neovascular age-related macular degeneration (nAMD) is a major cause of sight loss in older people and there are about 40,000 new cases in the UK each year.

The condition is due to the growth of leaky new blood vessels in the eye, caused by a protein called vascular endothelial growth factor (VEGF).

Without treatment, two thirds of people with the condition experience severe loss of sight within two years of being diagnosed.

Treatment of nAMD

The condition can be treated by drugs that reduce the effects of the VEGF protein.

A number of drugs are available that work in the same way to stop the production of VEGF.

Ranibizumab (Lucentis) is an expensive drug and currently licensed to treat nAMD.

However some clinicians were using a similar but much cheaper anti-VEGF drug, Bevacizumab (Avastin). These clinicians believed it was just as effective at treating nAMD and that if this could be proved, its use by the wider NHS would lead to huge savings.

Research into Lucentis and Avastin

In 2007, a team of researchers led by Professor Usha Chakravarthy, of Queen’s University, Belfast was funded by the NIHR Health Technology Assessment (HTA) programme.

They set out to compare Lucentis with Avastin in a randomised controlled trial, to find out whether Avastin was as clinically and cost-effective as Lucentis in treating nAMD.

The research, funded by the assessed 610 patients across 23 hospital ophthalmology clinics in England, Wales and Northern Ireland, with each participant being allocated one of the drugs and one of the dosing intensities.

Avastin trial results

The results showed that Avastin, currently licensed to treat cancer and costing £28 per injection, was just as good as (neither worse nor better) Lucentis, (£561 per injection) in terms of the patients’ best corrected visual acuity.

In the UK, if Avastin were used as the treatment of choice, the NHS would be able to save millions of pounds each year.

The results informed the National Institute for Health and Care Excellence (NICE) clinical guidelines on the treatment of nAMD, concluding that Avastin was as safe and effective as Lucentis.

The international impact of trials

The study findings have had an international impact, acting as the basis for recommendations made in the World Health Organisations (WHO) 2017 report ‘The selection and use of essential medicines’.

Direct effect of research on landmark court case

In September 2018, the research helped win a landmark court ruling between two drug companies and 12 Northern Clinical Commissioning Groups (CCGs) which focused on their decision to offer the drug which is not currently licensed to treat wet AMD.

David Hambleton, CCG Chief Officer, South Tyneside and former geriatrician said:

"The drug is undeniably equally effective, and much less expensive, and will save in excess of £13.5m per year for the 12 CCGs involved in this litigation alone, and hundreds of millions of pounds across the country."

Lead researcher Professor Usha Chakravarthy, Queen's University, Belfast said:

The team welcome the fact that the NHS will have the opportunity to extend the use of Avastin to routine clinical practice