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NICE introduces cost sharing scheme for sight drug

BMJ 2008; 337 doi: (Published 29 August 2008) Cite this as: BMJ 2008;337:a1487
  1. Roger Dobson
  1. 1Abergavenny

    Patients in England and Wales with one of the most common causes of blindness will be able to be treated with injections of ranibizumab (Lucentis) on the NHS under a cost sharing scheme announced by the National Institute for Health and Clinical Excellence (NICE).

    The final guidance states that the NHS should pay for the first 14 injections of ranibizumab for patients with the wet form of age related macular degeneration (AMD), with the manufacturer picking up the bill for any more that are needed. The drug costs more than £10 000 (€12 400, $18 280) for each eye treated with 14 injections.

    A second drug for the condition, pegaptanib (Macugen), has not been recommended by NICE, a decision that has been criticised by the Royal College of Ophthalmologists.

    The new guidance recommends the use of ranibizumab, which blocks vascular endothelial growth factor and stops abnormal blood vessel growth and bleeding beneath the macula, as long as a number of conditions are met, including evidence of recent progression of the disease.

    “Lucentis is an expensive drug, costing more than £10 000 for each eye treated,” said Andrew Dillon, chief executive of NICE. “But that cost needs to be balanced against the likely cost savings. It has been estimated that the costs related to sight impairment for patients treated with Lucentis are around £8000 cheaper than for patients who receive best supportive care over a 10 year period.”

    The decision was welcomed by the Royal National Institute for the Blind. “NICE’s guidance will finally bring an end to a cruel postcode lottery,” said Steve Winyard, head of campaigns with the charity. “We’ve been waiting for this for over two years. It is a victory for thousands, bringing overwhelming relief to desperate people across the country.”

    The manufacturer of ranibizumab, Novartis, said that the arrangement whereby the NHS would pay for only the first 14 injections would benefit patients. “This reimbursement scheme is an important collaboration that will ensure patients living with wet AMD in England and Wales receive the best possible care,” said Trevor Mundel, head of global development functions with Novartis.

    The Royal College of Ophthalmologists also welcomed the decision, but said it was concerned that NICE had dismissed an appeal by Pfizer to allow treatment with pegaptanib.

    “NICE has decided not to allow treatment with Macugen—even where patients are sensitive or allergic to Lucentis” said Winfried Amoaku, chairman of the college’s scientific committee. “This, in our view, unfairly penalises the 3% of wet AMD patients who may be allergic to Lucentis. This can result in severe inflammation in the eye that lasts several weeks. This type of reaction to the drug in itself can cause additional damage to the retina with further sight loss unrelated to AMD.”

    Another drug, bevacizumab (Avastin), which also works against vascular endothelial growth factor, and which is licensed to treat bowel cancer, has been used off label to treat AMD, but NICE was unable to make recommendations on its use in AMD because its manufacturer has not sought a license for this indication. Earlier this year, the US National Eye Institute announced a clinical trial in 1200 patients to compare ranibizumab with bevacizumab.


    • NICE technology appraisal guidance 155. Ranibizumab and pegaptanib for the treatment of age-related macular degeneration is available at Details of the US trial can be found at

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