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NICE set to block blindness drugs

Published on 15/06/07 at 03:47pm

Most patients in England and Wales will be denied access to drugs for the leading cause of sight loss if NICE doesn't change its draft guidance.

Novartis' Lucentis is recommended for use in just 20% of patients, but not until both eyes are affected and then only in the healthier one. Pfizer's Macugen has been blocked altogether.

Campaigners say this will condemn to blindness the 20,000 people that each year develop age-related macular degeneration or wet AMD.

The Royal National Institute of Blind People (RNIB) says it is outraged at the stringent guidance on the ground-breaking treatments, which is worse than they ever imagined.

Head of Campaigns Steve Winyard said: "[These] drugs have the potential to halve the number of people going blind each year and patients in the UK who can benefit from them must all have them - and quickly!"

The RNIB and fellow campaigners the Macular Disease Society say they will lobby for a re-analysis of the data on the two drugs.

NICE decided both drugs were clinically effective, but that Lucentis (ranibizumab) was associated with greater clinical benefit than Macugen (pegaptanib). It also found Lucentis to be cost-effective only in patients suffering from the classic CNV (choroidal neovascularisation) form of wet AMD - some 20% of patients.

Novartis said it was very disappointed in the guidance, which will allow a patient to go blind in one eye before they qualify for treatment.

Business Unit Director of Ophthalmology Joanna Potts commented: "The clinical and health economic data supports the use of Lucentis in all types of wet AMD and for both the first and second eye affected, yet NICE appears to have ignored this robust body of evidence. We will be making these comments in our response to this consultation document."

Wet AMD is the leading cause of sight loss in the UK and affects a quarter of a million people. The condition can lead to sight loss in as little as three months and requires prompt treatment if sight is to be saved.

But the drugs command a high price. Lucentis can cost more than £18,000 and  Macugen over £9,000  for a  two-year course of treatment.

NICE's chief executive Andrew Dillon said: "When treatments are very expensive, we have to use them where they give most benefit to patients."

He added that NICE's advisers believe the right thing to do is to treat and try to save as much sight as possible in the better-seeing eye, a decision reached in part because most AMD patients only seek help once the disease starts to affect their second eye.

The timing of NICE's decision once again highlights the difference between drug access in England and Wales and the situation in Scotland. Just one day before NICE issued its guidance, the SMC approved Lucentis, having recommended Macugen last year.

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