Addressing eye injection treatment options for retinal vascular disease, this article by Lishman Board Member, Peter Heyworth, has just been accepted for publication in the Australian Health Review. This article explores the the efficacy and cost of eye injection treatments Aflibercept (Eylea) and Bevacizumab (Avastin) and raises important questions regarding cost.
Bevacizumab for blinding eye disease – is it not time for the PBS to list for off-label use?
Abstract Anti-Vascular Endothelial Growth Factor (VEGF) eye injections have become the most accepted and effective treatment modality for some of the leading causes of blindness. Aflibercept (Eylea) is now the most expensive item on the Pharmaceutical Benefits Scheme (PBS) with ranibizumab (Lucentis) eighth. In 2011 the pharmaceutical cost for these treatments stood at $237 million – now the figure is $665 million and climbing.1,2 Bevacizumab (Avastin) is part of the original molecular lineage for this group of biologic agents which were originally designed for cancer therapy. It has now been administered world-wide on an off-label basis and in very large numbers for retinal vascular disease. It has a proven efficacy and safety profile.3 Bevacizumab is thirty times cheaper than the Therapeutics Goods Association (TGA) approved alternatives and its use could reduce PBS costs by hundreds of millions of dollars. Should the TGA be the sole arbiter in the approval of drugs, or should alternative bodies have some say in the approval of off-label usage under such compelling circumstances? Legislation for this approach has been approved in France, the UK and Italy.4,5,6 Only by eliminating the legal risk to authorising bodies and physicians as well as removing the financial disincentive to the patient associated with off-label use, will drugs such as bevacizumab be more widely adopted.
AH21379 Accepted 16 December 2021
© CSIRO 2021Australian Health Review