The last month has been an eventful one in the continuing debate over Lucentis and Avastin for wet age-related macular degeneration. The UK distributor Novartis has gone as far as to ask for “judicial review” of the policy of some primary care trusts in the South of England who have commissioned local Avastin services.
This news spread through the media and gave the impression that the NHS was being sued by Novartis in an attempt to protect profits and prevent PCTs from saving money by using Avastin. Evan Davis on the Today programme questioned the value of funding Lucentis claiming that the switch to Avastin could save the NHS the equivalent of 3000 extra nurses.
Novartis have since confirmed that they are not seeking to sue the NHS but to clarify the legal position of primary care trusts who choose to offer Avastin and limit access to Lucentis. The company has not helped its image by taking this action but on the specific issues being questioned they have a potentially strong case.
Based on guidance from the General Medical Council a doctor may choose to prescribe an unlicensed treatment if it serves the patient’s needs better than a licensed alternative. PCTs who commissioned Avastin services have sometimes done so by suggesting potential benefits of Avastin over Lucentis. This has not been confirmed in the comparative studies and the effect of the two drugs appears to be equivalent. A local decision to save money would lead to postcode based prescribing and it is hard to justify a decision to change on this basis of cost when the nationally appointed government body NICE has judged a treatment to be cost-effective.
Any change to Avastin would therefore need to be centrally led and regulated but such a move would be difficult for the NHS without undermining the drug regulatory process and negating the value of NICE in making decisions on what treatments should be funded. The results of this judicial review will certainly be of interest though and will likely shape the direction of future Avastin usage in the UK.