Government rules out Avastin use in AMD

The Minister for Life Sciences, George Freeman MP, made the comments in a letter responding to calls from clinical commissioning groups (CCGs) to review the off label use of the drug for use in patients with AMD which could dramatically cut costs for the NHS. 

In February, the heads of 120 CCGs wrote to the Department of Health asking the government and the National Institute for Health and Care Excellence (NICE) to reappraise Avastin and look at comparative cost effectiveness of Avastin alongside the NICE-approved treatments Eylea and Lucentis.

In his response, in a letter dated 23 March, the minister said: “The use of Avastin to treat AMD is an unlicensed use and setting a policy for routine use of Avastin on ground of cost alone is not therefore something I can support nor would it be prudent for me to risk public funds by underwriting it.”

Referring to the availability of licensed treatments, Mr Freeman writes: “These drugs also have positive recommendations from NICE technology appraisals that mean that they are cost-effective options for treating [AMD].”

The charity sector has welcomed the “clarity” of Mr Freeman’s response. Chief executive of the Macular Society, Cathy Yelf, said: “Drug licensing exists for the protection of patients and should not be disregarded for short term gains. We do however understand the frustration of many people in the NHS who are trying to save money so as to be able to treat more patients.” 

Ms Yelf added: “The licensed drugs for wet AMD are very expensive. In the longer term we may need to address the issue of how we can use good, cheap but unlicensed drugs safely and in the public interest.”

Expert analysis has estimated that switching to Roche’s cancer drug, Avastin, instead of the NICE-approved treatments, could save the NHS more than £100m a year. However, the drug is not licensed for treating AMD by drug regulators in Europe or the UK, which has raised concerns around liability for doctors using the drug on the grounds of cost-saving. 

A recent investigation published in the British Medical Journal has alleged that the pharmaceutical industry has also played a role in blocking the use of Avastin by UK doctors.