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Why have UK doctors been deterred from prescribing Avastin?

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1654 (Published 01 April 2015) Cite this as: BMJ 2015;350:h1654
  1. Deborah Cohen, investigations editor, The BMJ
  1. dcohen{at}bmj.com

Doctors in England’s NHS have been left seemingly unable to prescribe a cheap, safe, and effective drug despite its flourishing use elsewhere in Europe and the US. In the first of a two part investigation Deborah Cohen examines which agencies are responsible, whether commissioners and prescribers actually have more freedom to use intravitreal bevacizumab than might at first seem to be the case, and whether the UK’s drug marketing authorisation system really acts in the best interests of public health

Despite widespread critical coverage in The BMJ and elsewhere, the dominance of expensive drug ranibizumab (Lucentis) over cheaper bevacizumab (Avastin) to treat wet age related macular degeneration (AMD) continues unabated in the UK.

New evidence uncovered by The BMJ raises questions about the legal and regulatory positions that have skewed clinical practice, fuelled drug costs for the NHS, and left doctors confused about what they can and can’t prescribe. But in recent weeks clinical leaders have begun to fight back. Over 100 clinical commissioning groups (CCGs) in England have written to the health secretary, NHS leaders, and the General Medical Council, urging a resolution. The current situation is “untenable,” they say. Allowing CCGs to use bevacizumab instead of ranibizumab could release £102m (€138m; $152m) a year for patient services.

The NHS spends £244m a year on ranibizumab, the second highest amount for any drug.1 However, research and development costs do not explain why ranibizumab is priced 10-20 times higher than bevacizumab, Philip Rosenfeld, professor of ophthalmology at the Bascom Palmer Eye Institute in Florida told The BMJ. He was involved in the early phase trials of ranibizumab and was one of those who pioneered the use of bevacizumab for wet AMD. He said bevacizumab is also more expensive to make than ranibizumab.

Ranibizumab is a monoclonal antibody fragment …

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