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Licence to save: a UK survey of anti-VEGF use for the eye in 2015

2016; Springer Nature; Volume: 30; Issue: 11 Linguagem: Inglês

10.1038/eye.2016.154

1476-5454

Ahmed Shalaby, Karinya Lewis, Kate Bush, Paul R. Meredith, Sandro Di Simplicio, Alastair Lockwood,

Renal and Vascular Pathologies

Anti-vascular endothelial growth factor (anti-VEGF) injections have revolutionised vision for patients with macular degeneration or diabetic macular oedema.However, the choice of anti-VEGF is controversial.Two drugs licensed for macular oedema are ranibizumab (Lucentis) and aflibercept (Eylea).A third drug, bevacizumab (Avastin), is only licensed for colorectal cancer, and therefore, use in the eye is 'off label'. 1 Yet, all three are effective.Independently supported randomised controlled trials, 2,3 and systematic reviews were unable to find a significant difference in safety or efficacy. 4,5he cost difference is significant however.Prices, according to the British National Formulary (BNF), are: ranibizumab; £742 per single injection vial, aflibercept; £816 per single injection vial; bevacizumab £242.66 per vial, but in practice each bevacizumab vial is divided into 20 injections, giving a price of £12.13 per injection. 6 In each case, these costs are multiplied many times over, because patients require repeated injections.Given the current government's cost-cutting ambitions, 7 we hypothesised the majority of injections would use the less expensive drug, bevacizumab.We therefore performed a freedom of information (FOI) request to all UK NHS ophthalmological units for the number of ranibizumab, aflibercept, and bevacizumab injections prescribed during January 2015 (Table 1 and Figure 1).These results indicate the anti-VEGF injection cost to the NHS.Contrary to the hypothesis, the vast majority (97%) were with the more expensive drugs ranibizumab and aflibercept.If all injections used divided bevacizumab, the estimated cost would be £607 749 (£729 500 incl.VAT) saving the NHS £449 196 354 (£539 035 492 incl.VAT) per year.With 5% unaccounted for, savings may be greater.