Commentary: NHS patients should have a choice of drug for wet age-related macular degeneration, despite pressure from pharma



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Commissioners have to pay more than lip service to the obligation on us to find cost effective treatment options. Our 12 clinical commissioning groups (CCGs) have therefore agreed a policy to offer the thousands of patients in our region diagnosed with wet age-related macular degeneration (AMD) every year the choice of bevacizumab as preferred treatment.

That bevacizumab is as clinically effective and safe as aflibercept and ranibizumab—which patients will continue to be offered as alternatives—has been shown comprehensively.1 We intend to share information with patients through accessible media (including leaflets and audiovisual material) about the treatment options available, the evidence base, and the comparative costs—and allow them to make their own choice.

The policy could save the region’s NHS up to £13.5m (€15m; $18m) a year over the next five years. That could pay for an extra 270 nurses or 266 heart transplants every year. In a financially stretched NHS, the alternative for CCGs is that we may have to make less evidence based savings, including rationing other treatments such as in vitro fertilisation.

Every patient who chooses the cheaper alternative drug will help the NHS to fund important medical treatment in other areas. We want to have informed conversations with our patients so that they understand the wider effects of the choices…