There has been much discussion over the subject of AMD treatments the table below lays out the costs to the NHS for drugs in hospitals in 2012. The cost of Lucentis at that time was £193 million. Since then drug prescribing for AMD has changed Eyelea is now probably the top drug.
Table 2. Top 10 medicines by cost for medicines positively appraised by NICE issued
in hospital in 2012
||NHS Cost £ (thousands)
|Etanercept (Enbrel, Pfizer)
|Ranibizumab (Lucentis, Novartis)
|Rituximab (MabThera, Roche)
|Infliximab (Remicade, MSD)
The interesting wording on the table is ‘positively appraised by NICE’ . There was much discussion about the drug Avastin a very similar drug to Lucentis it had been developed for a very different probem. It first gained approval in the US to fight colon cancer, but was subsequently discovered to be effective against AMD.
The interesting thing about it was that its cost was roughly 15x cheaper than Lucentis. The NHS could have saved £180 million pounds by switching from just one drug to another. Why didn’t they do this? Well the simple answer was that Avastin was not NICE approved so clinicians were unable to use it. Why didn’t NICE approve it? NICE can only approve drugs that are submitted to it, if they are not submitted they are not used.
Avastin is a drug developed by Roche, Lucentis was developed by Novartis, who have a holding in Roche. Roche for some reason never felt the need to submit Avastin to NICE maybe they didn’t want to sell their drug to the NHS, I can’t for the life of me think why?…
The idiocy of NICE is stunning it is the National Institute for health and Care Excellence, common sense doesn’t seem to come in to it. Let us hope Novartis spent their £180 million pounds on lots of research into AMD.
Exciting news about robot surgery in the press. The reports highlighted new robot equipment to do surgery on the back of the eye. While this is not directly linked to AMD at this stage it is extremely good news.
The operation done in Oxford was a macula peel operation. This is when the fine membrane that is between the retina and the vitreous humor is removed. This operation has only been possible over the last ten years or so. It is an incredibly delicate piece of work, I have great admiration for the guys who perform this daily. They are working with operating microscopes all the time, it is like peeling off that layer of membrane that attaches to a boiled egg, between the shell and the egg. They are doing this inside the eye. Read the report at The Guardian or see the report BBC news report.
The reason it is so important is that in the next few years stem cell therapy will be started for AMD. The ability to use robots for this type of surgery will raise the success rates when it eventually starts as it will be comparable in complexity to macula peel operations now. This is one of those stepping stones necessary to make future treatments more likely and more successful.
The company that developed the robots is Preceyes look them up for more information.
There are many products aimed at people with MD from treatments to equipment. There are too many on the market for me to analyse all of them in depth. However, I will point out the stuff that I have been acquainted with over many years, the stuff that has endured and the stuff that is new to the market that seems to be good.
The world of macular degeneration falls into three distinct phases:
- Following initial diagnosis of the disease when one or both eyes have early signs of macular disease.
- When there is a significant loss of vision in one eye, but the vision is still good in the second eye.
- When there has been significant visual loss in both eyes, this is when registration for either partially sighted or blind registration may be considered.
Each of these stages presents different challenges to the individual. As you progress through them others get caught up in the consequences. Few people battle on alone family and friends are bought on board as situations and problems present themselves. This blog is for all those who get caught in the web of macular disease, whether they have it or are on the sidelines watching but not knowing what to do or say.