Tuesday, January 27, 2009
In an interview with retina specialist Sophie Bakri, MD of the Mayo Clinic, Dr. Winfried Amoaku discusses ophthalmology in the context of the UK’s National Health System.
Treatments for macular degeneration in the UK: offering laser treatment for extrafoveal neovascular membrane. For subfoveal or juxtafoveal they offer PDT for predominantly classic lesions, and then the anti-VEGF treatments. Just as in the US, Lucentis is approved but Avastin is available off-label for some patients (based in financial constraints). Macugen is not considered cost-effective. Until NICE approved the use of Lucentis, many patients paid for the treatments out of pocket (either Avastin or Lucentis). Private sector vs. NHS treatments do differ because drugs are typically available considerably earlier in the private sector.
The process for drug approval in the UK: National Institute of Clinical Excellence (NICE) evaluates pharmaceutical candidates referred to them from the Department of Health. They then establish a committee to evaluate the drug. Approval can take from 3 months to 2 yrs (e.g., Lucentis and Macugen were 2 year approval). Many factors are weighed in approval including the final clinical use protocols. In ophthalmology, treatment of only one eye is sometimes deemed sufficient. An appeal processes exists to change the committees final decision however. Compromises are often required (e.g., Novartis example). The IVAN study is currently underway in the UK comparing Lucentis and Avastin (with 600 patients).
As Vice President of the Royal Academy of Ophthalmologists, it is Dr. Amoaku’s responsibility to manage the scientific content of annual congresses and to aid in fundraising for ophthalmic research.