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Primary care trusts reverse advice to ophthalmologists to use cheaper drug for wet age related macular degeneration

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5161 (Published 30 July 2012) Cite this as: BMJ 2012;345:e5161
  1. Nigel Hawkes
  1. 1London

A group of primary care trusts in southern England has discontinued its policy of funding the anticancer drug bevacizumab (marketed as Avastin) as an alternative treatment for wet age related macular degeneration (wet AMD).

The U turn by the Southampton, Hampshire, Isle of Wight, and Portsmouth cluster of primary care trusts came after Novartis, which markets a licensed drug for the condition, ranibizumab (Lucentis), successfully sought a judicial review of the cluster’s policy.1

Bevacizumab is unlicensed for wet AMD but has a similar mode of action, works nearly as well, and is much cheaper. By allowing ophthalmologists to prescribe it rather than ranibizumab, the cluster of trusts had hoped to save as much as £5m (€6.4m; $8m) a year.

At a board meeting on 25 July the cluster revoked the policy after considering a review paper prepared for it by a team that included its medical director, Stuart Ward. The review listed a series of arguments for changing tack, which included the pending legal action, the reluctance of ophthalmologists to prescribe bevacizumab, guidance from the General Medical Council, and an offer by Novartis to negotiate a lower price for ranibizumab. The board accepted the advice.

In many parts of the world, including the United States, bevacizumab is used more commonly than …

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