Slashing the budget – Avastin vs. Lucentis

Currently the effects of late-stage AMD cannot be reversed and there is no cure for any stage. Rather treatments are used to prevent the development of the vision destroying condition, usually through an intravitreal injection.

The most commonly used treatment for AMD in the UK is a drug named Lucentis. This treatment must be administered directly through the vitreous humour once a month via an injection. Side effects can include conjunctival haemorrhaging, eye pain, and vitreous floaters. At around £700 per injection the cost of Lucentis can put a large amount of strain on the healthcare systems budget and, if done privately, the patient.

A form of AMD treatment currently in trials is Avastin, a drug formerly used to treat several types of cancer. Avastin, like Lucentis, must also be administered as an intravitreal injection but unlike Lucentis it does not carry a heavy price tag. At a more reasonable price of £60 per dosage Avastin could save the NHS over £84m a year, taking some financial strain off the public healthcare system.

Unfortunately Avastin is yet to see widespread usage in the UK as the cancer drug will need to go through more clinical trials to be approved for treating AMD, meaning that it is only used at the discretion of some clinicians currently.

A team of scientists and eye specialists from 23 hospitals and universities across the UK have further tested Avastin in a clinical trial known as IVAN.

As of now the study has lasted five years, looking at the effects of both Lucentis and Avastin comparatively. To do this 610 patients with wet AMD entered the trial, some being given Lucentis and some Avastin either at regular monthly intervals or when needed. The aim is to discover whether Avastin is as effective as Lucentis without showing any serious adverse effects.

So far IVAN has shown that the two drugs are extremely similar, however, adverse effects have occurred more often in both groups of patients in the sub-groups which were given medication when needed.

If Avastin continues to show that it is equally as, or more than, effective as Lucentis then this study could save millions of pounds and have a huge impact on healthcare. “The findings of the IVAN study will be of great importance for the management of patients with wet AMD throughout the world,” says Professor Ian Young, director of research and development at the Belfast Health and Social Care Trust.

Despite the reduced costs systems such as the NHS will continue to struggle with other factors when treating AMD, for example the time demands put on eye experts and additional strain on Avastin resources for anti-cancer treatments.

The best way to take strain off healthcare systems would be to work at preventing the development of AMD. By doing this less people will need to have treatments leaving more time and funding for eye care experts to focus upon other health issues.

By installing an MPS II macular pigment reader in a clinic optometrists are able to determine how much risk a patient is at of developing AMD. The fast and simple test will allow the professional to give their patient the right advice as quickly as possible and, if needed, dispense oral supplementations like the AREDS formula before the macular degeneration reaches a more serious stage.

The MPS II system is also extremely cost effective, especially in comparison to both monthly treatments of either Avastin or Lucentis. If a practice invested in the device for £6,000 it would take just 300 patients to have a £20 eye exam in order to cover the initial cost.

Upon reviewing the cost-effectiveness of the MPS II, leading consultant Dr Scott Mackie saw “a notable percentage of patients with [AMD] risk factors.”  Through early detection Dr Mackie was able to prevent possible sight loss in many of his patients, establishing a strong, healthy relationship with them, improving the credibility of his practice, and avoiding the need for further treatments.