All those in favour say “Eye”

A relatively new drug called ranibizumab (Lucentis) can cause an improvement in diabetic macular œdema when it is injected into the eye.  According to this article, the National Institute for Health and Clinical Excellence (NICE) has just recommended that NHS doctors do not prescribe this drug.  Why should this be when it has been shown to be effective?

There are three probable reasons.

Firstly, it costs about £742 a dose.

Secondly, there is a more cost effective treatment, laser photocoagulation, available.

But it is the third reason that is really interesting and a reflection on how the pharmaceutical industry functions.  There is another drug, bevacizumab (known by the trade name Avastin), which is used to treat bowel cancer.  It has similar effects on diabetic macular œdema as Lucentis and only costs £5 a dose.  However, it does not have a product licence for this condition and is not likely to get one.

Why?

The company manufacturing Avastin are not going to apply for one.

Why ?

Because the patent on Avastin is about to expire and it would not be economic for the company to jump through all the legislatory hoops to get a product licence when the drug will soon be even cheaper than it is at present.

It is not actually illegal to prescribe a drug without its product licence.  It is called named-patient prescribing.  It has, in the past, covered things like using the oral contraceptive pill as a “morning-after” pill.

So, if you find your patients coming home from the diabetes clinic with a prescription for bevacizumab, don’t worry that they have developed bowel cancer.  It is more likely that the consultant is finding a neat way round a complex problem.

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