Eye surgeon calls for Avastin on the NHS
A leading consultant ophthalmic surgeon has called for
the incoming government to allow the use of Avastin, a much cheaper
age-related macular degeneration (AMD)drug than Lucentis, on the
NHS.
Mr Mike Lavin, a surgeon at the Manchester Royal Eye Hospital
with a private practice, said: 'Gordon Brown and Patricia Hewitt
blocked NHS access to both Avastin and Lucentis in 2006, 2007 and
2008, despite the fact that these drugs were widely available in
other countries for the treatment of macular disease.
'In the future we need to ensure less political interference and
more freedom for doctors to use the best treatments on the basis of
scientific evidence regarding benefit, safety and relative
cost.'
The Department of Health has asked NICE to consider assessing
the use of Avastin, which is currently licensed in the treatment of
bowel cancer, for the treatment of wet AMD. Meanwhile, the
Rarer Cancers Forum says NICE averages 21 months to issue guidance
for new cancer treatments, meaning that even if a drug eventually
gets the nod, potential beneficiaries often miss their window of
opportunity to use it when it would have the most impact.
Explaining the dilemma for NICE in assessing Avastin Lavin said:
'NICE cannot examine Avastin without permission from the drug
owner, which makes both Avastin and Lucentis, so it's not in their
interest to let NICE look at Avastin for this issue and NICE can do
nothing about that.'
Revealing how much money is at stake over the issue, Lavin said
that in the US a single dose of Avastin for injection into the eye
costs around $20, whereas Lucentis was first priced at £1,000 per
injection in the UK and now costs around £700 per injection.
Rejecting the argument that Avastin should not be used in the
eye as it is only licensed for the treatment of bowel cancer, Lavin
said: 'The NHS uses other licensed drugs off label, aspirin is
licensed for pain relief but is widely used off label for the
treatment of heart disease.
'Avastin has been used in more patients worldwide than Lucentis.
It has been used in higher doses than Lucentis and is used in the
eye at a dose that is 0.3 per cent of the licensed dose. Whereas
Lucentis has never been given outside the human eye into the whole
body, it is used at 100 per cent of the licensed dose and nobody
knows what it does to the whole body. For all these reasons doctors
should be more comfortable using Avastin than Lucentis.'
The National Institute for Clinical Excellence or NICE, curbs
NHS spending by rejecting or limiting treatments it deems
insufficiently cost effective; targets in the past have included
the multicancer drug Avastin, despite many petitions from the
public to make it available.
The Wall Street journal, in an article today, speculates that
the recent promise of David Cameron's new coalition to reform NICE
so that "all patients can access the drugs and treatments their
doctors think they need", carries the 'whiff of market-based
reform', but when decoded means the opposite. "Value-based pricing"
translates to expanding Westminster's power to limit pharmaceutical
prices, which the WSJ says will do little to improve Britons'
limited access to life-extending and life-improving drugs.
The UK has among the First World's worst survival rates for
cancer and other grave illnesses. Whilst the government is
separately pledging a fund to pay for cancer drugs rejected by
NICE- this is an expensive move that won't cover other illnesses
such as Alzeimers, MS and Heart Disease.
The drug, first approved by the FDA in 2004, was first developed
as a genetically engineered version of a mouse antibody that
contains both human and mouse components. The drug manufacturer,
Genentech, is able to produce the antibody in production-scale
quantities. As Avastin is currently marketed and sold as a
cancer treatment drug, it could possibly fall into the category
covered by this fund- but it seems that the drug manufacturer, will
fight it's use as a treatment for Macular Degeneration every step
of the way, in order to protect it's own profit margins.
Off-label use of Avastin has been controversial. Due to the
concentration in which Avastin was sold; it was required that
compounding pharmacies reformulate the drug into more dilute
concentrations in order to be used to control AMD. In October 2007
Genentech issued a letter to Physicians stating that it would "no
longer allow compounding pharmacies to purchase Avastin® directly
from drug wholesalers" as of November 30, 2007. This would
effectively stop its use for macular degeneration patients who had
no insurance coverage for Lucentis and for any patient who had
other vision threatening conditions where Avastin has been shown to
work.
However, the ophthalmic community, led by the American Academy
of Ophthalmology (AAO) and the American Society of Retinal
Specialists (ASRS), fought back and managed to get Genentech to
agree to continue providing Avastin to retinal surgeons, who in
turn could get compounding pharmacies to "cut" the dosage to the
appropriate ophthalmic dosage for continued use.