Intended for healthcare professionals

Letters Age related macular degeneration

Cost comparison of ranibizumab and bevacizumab

BMJ 2011; 343 doi: (Published 23 August 2011) Cite this as: BMJ 2011;343:d5058
  1. Timothy L Jackson, Higher Education Funding Council for England senior clinical lecturer and honorary consultant ophthalmic surgeon1,
  2. Lucy Kirkpatrick, trial facilitator, research office1
  1. 1Department of Ophthalmology, King’s College Hospital, London SE5 9RS, UK
  1. t.jackson1{at}

Wet age related macular degeneration (AMD) is the leading cause of blindness in the UK.1 Most UK patients are treated with ranibizumab (Lucentis, Novartis), according to National Institute for Health and Clinical Excellence (NICE) guidance. The NHS pays for the first 14 injections; thereafter, the cost is reimbursed by Novartis, but the NHS still spent £138m (€159m; $225m) on ranibizumab in 2010.2

The CATT trial reported that bevacizumab produced an equivalent visual outcome but cost $385 per patient per year compared with $13 800 for ranibizumab.3 Although ranibizumab is licensed for the treatment of wet AMD, bevacizumab is not. Both drugs are owned by Genentech. Many UK healthcare commissioners are requesting that ophthalmologists prescribe bevacizumab instead of ranibizumab to reduce costs.4

We undertook an economic evaluation that included a UK comparison of ranibizumab and bevacizumab.5 The figure shows our projection extended to 13 years, the average life expectancy of someone diagnosed with wet AMD.


Per patient cumulative treatment costs for bevacizumab and ranibizumab. Projections include NHS drug costs, outpatient charges, and cost of giving intravitreal injections. Costs are for treatment naive patients and those who have had eight previous injections of ranibizumab

Over a three year projection, the cost of ranibizumab would need to be reduced to £235 (from £913), with retention of the reimbursement scheme, to give equivalent costs in treatment naive patients. In previously treated patients this figure is £550. If drug costs remained unaltered the NHS could save £190m over three years, using bevacizumab to treat 26 000 new cases each year. It is estimated that 414 561 patients have wet AMD.6 Assuming NICE’s estimate of 80% eligibility, eight previous injections of ranibizumab,5 and an annual death rate of 7.7%,7 then a switch to bevacizumab would save £556m over three years.

These projections involve several assumptions and caveats, detailed in our report.5 They do not consider any potential differences in safety, medicolegal risk, treatment burden, or patient preference, and neither do they recognise commercial drug development costs. Nonetheless, there seems to be an economic argument for adopting bevacizumab in treatment naive patients or renegotiating the cost of ranibizumab.


Cite this as: BMJ 2011;343:d5058


  • Competing interests: No competing interests related to this work itself. TLJ has received research funding from NeoVista, Novartis, Oraya, and Thrombogenics; he has worked as a consultant to, or is on the advisory board of, DORC, Thrombogenics, Bausch & Lomb, NicOx, and Merck. LK has received funding from NeoVista.


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