Commissioners call for Avastin AMD appraisal

The leaders of 120 Clinical Commissioning Groups (CCGs), accounting for 60% of all CCGs, have appealed to the General Medical Council, NHS England and the Department of Health to remove current barriers which restrict the use of the drug to treat AMD.

This latest call follows a string of previous attempts by commissioners, charities and eye health experts to force a change. While Avastin is not approved for use in patients with wet AMD, it can be used off-label, at the practitioner’s discretion.

Chief clinical officer at NHS Blackpool CCG and chair of NHS Clinical Commissioners, Dr Amanda Doyle, said: “This is a long standing issue within the NHS and the number of CCGs who have united behind this shows the strength of feeling there is to ensure that we have all the available options to be able to deliver the best possible care for our patients.”

The National Institute for Health and Care Excellence (NICE), which appraises drugs for the NHS, currently recommends Lucentis (ranibizumab) and Eylea (aflibercet) for the treatment of wet AMD. However, Avastin is significantly cheaper with previous analysis has suggested that switching to the drug could save the NHS over £100m a year.

In addition, a review published by the Cochrane Library last year dispelled safety concerns around the drug, finding that Avastin was safe in clinical trials, with a comparable efficacy profile to recommended treatments. However, proceedings have reached a stalemate, with NICE unable to carry out an appraisal without the go ahead of the Department of Health, who in turn have stated an appraisal is not necessary as a licensed therapy is available, and that they have received no request from the drug manufacturers for additional appraisals.

Dr Doyle said: “As clinicians we are seeing an increase in the incidence of this chronic eye condition due to an ageing population, and as commissioners we have a responsibility to ensure that every pound spent is done so to the best effect, and that is even more important with the current financial pressures the NHS is facing.”

She added: “Members of the public would be baffled if they knew the sums of money being spent on expensive drugs when there is an alternative available that is cheaper and as effective.”

The group of clinical leaders are asking the secretary of state for health to reconsider the status of the drug and for NICE to undertake a multiple treatment appraisal to compare the cost effectiveness of Avastin with recommended treatments. They are also asking the GMC to provide a specific exception to their guidance around the drug and support practitioners wishing to use it in an off-label capacity.

The College of Optometrists has welcomed the calls from NHS Clinical Commissioners, highlighting the potential benefit for savings to be reinvested in frontline delivery of eye services.

Responding to the calls, president of the College of Optometrists, David Parkins, said: “The College acknowledges the need for debate around a review of the use of Avastin to effectively treat wet AMD, but our primary responsibility is to ensure patients receive the best possible treatments for their eye conditions, and for doctors to be able to make the right choice of treatment for their patients.”