NHS victory in landmark legal case to mean cheaper treatment for thousands of wet AMD vision loss patients at Sunderland Eye Infirmary

Dr Lawrence Gnanaraj
Dr Lawrence Gnanaraj

NHS bosses have today won a landmark legal battle against two multinational drug firms over treatment of the biggest cause of age related vision loss in the UK - and thousands of Sunderland Eye Infirmary patients are set to benefit.

Today's victory for the 12 Clinical Commissioning Groups (CCGs) in the North of England - covering Sunderland, South Tyneside and Hartlepool - means they can now offer Avastin as a treatment to patients with wet age-related macular degeneration (wet AMD).

The condition, which affects tens of thousands of people in the UK – including 3000 newly diagnosed patients in the North East and north Cumbria alone - is currently treated using either Lucentis, sold by Novartis, or Eylea, sold by Bayer.

The two pharmaceutical firms had tried to stop the CCGs from offering Avastin - which NHS bosses describe as an ‘undeniably effective and less expensive’ alternative treatment and being around 30 times cheaper than the most expensive alternative.

Health leaders and clinicians have welcomed the High Court Judgement and say potential national savings of hundreds of millions of pounds could be redirected into vital resources and treatments, including medical equipment and life-saving operations across the country.

Avastin is widely used around the world for the treatment of the potentially devastating eye condition, and has been found by The National Institute for Health and Care Excellence (NICE) to be just as clinically effective and safe as the other two more costly brands.

The news has been welcomed by experts at Sunderland Eye Infirmary, which currently treats around 3000 active patients with wet AMD and sees over 450 new patients every single year.

It runs 35 wet AMD clinics every week and runs 23 injection lists every week – 90% of which are nurse delivered.

Last year, the Infirmary delivered 15822 injections for patients with wet AMD and is expecting this figure to exceed 17,000 in 2018.

Dr Lawrence Gnanaraj, a Consultant Ophthalmologist and Clinical Director at the Sunderland Eye Infirmary, a regional centre of excellence in the North East of England which cares for thousands of patients across the region with wet AMD, added: "Today’s decision is very positive news not only for our patients here in Sunderland and the North East, but potentially across the whole NHS.

"As clinicians, we understand the importance of ensuring value for money for the NHS and we have supported the introduction of a policy across the North East and North Cumbria which not only offers increased patient choice, but also has the potential to substantially reduce costs for the NHS which can be reinvested directly back into patient care.

"Ultimately, the treatment decision for every individual patient will always be based on efficacy, safety and fully informed patient choice. Today’s ruling means we can now offer our patients the choice of Avastin which the National Institute for Health and Care Excellence (NICE) has found to be just as clinically safe and effective.”

The 12 CCGs involved in the legal battle were Northumberland; Newcastle Gateshead; North Tyneside; South Tyneside; Darlington; Durham Dales, Easington and Sedgefield; North Durham; Hartlepool and Stockton-on-Tees; North Cumbria; Sunderland; Hambleton, Richmondshire and Whitby; and South Tees.

Dr David Hambleton, CCG Chief Officer in South Tyneside, former consultant geriatrician and lead on behalf of the North East and North Cumbria CCG Forum, said: "We are absolutely delighted that we are now in a position to offer Avastin as an alternative treatment for wet AMD to our patients across the North East and North Cumbria.

"The drug is undeniably, equally effective, and much less expensive, and the money this will save – in excess of £13.5 million per year for the 12 CCGs involved in this litigation alone, and hundreds of millions of pounds across the country – can be ploughed straight back into delivering the very best care possible to our patients.

"Here in the North, that’s enough to pay for an extra 270 nurses or 266 heart transplants every year, and in a financially stretched NHS that could be life-changing for thousands of our patients.

"Novartis and Bayer have argued long and hard for the more expensive drugs they’d rather sell to be the only ones available to people suffering from this condition but thankfully, the court has recognised that there is no medical basis to that argument. This is great news for patients with this condition and for the wider NHS. It’s a victory for common sense over commercial interests.

"The sooner all NHS Trusts implement a policy to offer Avastin as an option for the treatment of wet AMD the sooner we can start to redirect that money into other resources and equipment so we can continue to make improvements to care which have life changing benefits for our patients.

"It is right to offer our patients this choice, because the beneficiaries will be their friends, neighbours and family members.”

"We know that patients value the care and support from NHS in region and will choose this new option which is just as effective and safe.

"It is also good news for clinicians – we know that some doubt has been created in people’s minds by the pharmaceutical companies but this has provided clarification and clinicians can now be reassured."

WHAT IS Wet AMD?

* Wet AMD results in sight loss caused by the abnormal growth of new blood vessels beneath the macula of the retina. That growth is stimulated by a protein known as vascular endothelial growth factor (VEGF). Wet AMD can be treated by using drugs that inhibit VEGF. The most common way of treating wet AMD is injecting anti-VEGF agents into the eye.

* Lucentis and Eylea cost somewhere in the region of £800 per injection. By contrast, Avastin costs around £28 per injection.

* Avastin is the drug of choice in the private sector in this country. It is used extensively in the USA and across Europe. NICE updated their guideline In January 2018 in which they concluded that there was no clinically significant differences in effectiveness and safety between the 3 anti-VEGF treatments.