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Sandro Di Simplicio, Ahmed Shalaby, Karinya Lewis, Kate Bush, Paul Meredith, Alastair Lockwood; A UK survey of anti-VEGF use for the eye in January 2015. Invest. Ophthalmol. Vis. Sci. 2017;58(8):868.
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© ARVO (1962-2015); The Authors (2016-present)
The use of anti-vascular endothelial growth factor (anti-VEGF) injections has revolutionised visual prognosis in macular degeneration and diabetic retinopathy.However, the choice of which anti-VEGF drug to use is controversial. Two drugs that are ‘licensed’ for these indications are ranibizumab (Lucentis) and aflibercept (Eylea). A third drug, bevacizumab (Avastin), is ‘licensed’ only for use in the treatment of colorectal cancer, and therefore use in the eye is ‘off label’.The purpose of our survey is to evaluate the cost-effectivness and the possible saving for the NHS if bevacizumab was used as a first line treatment.
A freedom of information (FOI) request was submitted to all UK NHS Trusts and Health Boards with an ophthalmological unit. The list of ophthalmological units was obtained from the Royal College of Ophthalmologists. The request included the total number of intravitreal injections of ranibizumab, aflibercept, and bevacizumab prescribed during the month of January 2015. A one-month time period was considered by the authors to be sufficient to give an accurate estimate of incidence of injections.
A total of 189 Freedom of Information (FOI) requests were sent to 163 NHS Trusts in England, 14 Health Boards in Scotland, 7 Health Boards in Wales and 5 Health and Social Care Trusts in Northern Ireland. The overall response rate was 95.8%.A total number of 501,103 anti-VEGF injections were performed in the UK in January 2015. Ranibizumab injections made up 61.1%, aflibercept were 36.0% of the whole and bevacizumab made up 2.8%.
The results capture the frequency of anti-VEGF injections performed across the UK and indicate the scale of cost to the NHS. Contrary to our hypothesis we found that the vast majority (97%) of anti-VEGF injections performed in the UK still used the more expensive drugs ranibizumab and aflibercept. If all injections were performed using divided bevacizumab, the estimated drug cost would be £ 607,749 (£ 729,500 incl. VAT) saving the NHS £ 449,196,354 (£ 539,035,492 incl. VAT) per year. With 95% of responses from the UK’s NHS Trusts eligible for our study, 5% remain unaccounted for, and therefore the savings may be greater.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Number of IVIs by molecule
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