- The World Health Organization (WHO) has rejected Novartis' request to add Lucentis (ranibizumab) to the List of Essential Medicines to treat AMD (wet age-related macular degeneration), a leading cause of blindness.
- The List of Essential Medicines is used by governments worldwide to determine which treatments they should make available.
- This debate has been going on for some time, with various physicians and payers saying that although Lucentis is indicated for treatment of AMD, Avastin is equally safe and effective, yet costs 1/40th the price of Lucentis.
The backstory takes us back to 2013, when the WHO decided to put Avastin on the List of Essential Medicines for macular degeneration, at which point Novartis chimed in and requested that Lucentis be added to the list for treatment of AMD as well. The list has just been updated, and while Avastin is endorsed for treatment of AMD, Lucentis is not, and the two drugs' maker (Roche/Genentech) has refused to pursue an official AMD label for Avastin. Novartis markets Lucentis in Europe.
There has been ongoing controversy as Novartis has raised the specter of widespread off-label usage of Avastin for AMD, but a great deal of research has been conducted and it has become clear that Avastin is suitable for treating AMD—and at much lower cost. Most recently, a Cochrane review concluded that Avastin is of comparable efficacy and safety to Lucentis for treating AMD---a very high-level foundation for chooisng Avastin over Lucentis. And when you add the cost parameters from IVAN, a head-to-head trial funded by the UK goverment, the financial implications become even clearer. Based on IVAN, the average cost of treating AMD for two years with Lucentis is $28,600, compared with $4,638 for Avastin.
Based on all of the available data, it looks as if the UK's National Institute for Health and Care Excellence will be choosing Avastin for AMD as well; however, that isn't a sure thing until the new treatment guidelines on macular degeneration are finalized.