First Author: A.Shalaby UK
Co Author(s): P. Meredith K. Lewis A. Bush S. Di Simplicio A. Lockwood
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Bevacizumab, a drug licensed in the UK (UK) for colourectal cancer, is proven to have similar efficacy and safety in the eye to the anti-VEGF drugs ranibizumab and aflibercept, which are licensed for intraocular use, and bevacizumab is significantly cheaper. Given the current UK government’s ambition to reduce the costs of health care we hypothesised that the majority of injections would be with the less expensive drug, bevacizumab. We therefore undertook a national survey to determine whether bevacizumab is the anti-VEGF treatment of choice in the UK National Health Service
A freedom of information (FOI) request was submitted to all (189) UK NHS Trusts and Health Boards with an ophthalmological unit requesting the number and cost of intravitreal injections of ranibizumab, aflibercept, and bevacizumab prescribed during the month of January 2015. Non-NHS units were excluded. Costs per month were determined by multiplying injection numbers with latest British National Formulary (BNF) prices, and then by 12 for yearly costs. BNF prices: - ranibizumab; £742 per single injection vial - aflibercept; £816 per single injection vial - bevacizumab £242.66 per single vial* *In standard practice each vial is divided into 20 injections, giving a price of £12.13 per injection
The overall response rate was 95.8%. Fifty-three (28.0%) Trusts confirmed that they do not provide intravitreal injection services (49 in England, 3 in Northern Ireland and 1 in Wales). Two responses were excluded due to incomplete data. Those that responded represent approximately 90% of the UK population. In the month of January 2015 a total of 50,103 intravitreal injections were performed in the NHS in the UK. Of these 1410 (3%) were bevacizumab, 30,634, (60%) were ranibizumab, and 18,059 (37%) were aflibercept (Figure 1). Assuming BNF prices this equates to a monthly cost to the NHS of £45 million (equivalent to £540 million per year, Table 1).
UK practice still vastly favours the expensive drug ranibizumab as anti-VEGF of choice despite good evidence of safety, efficacy, cost savings, and support from respected professional bodies for bevacizumab. £45 million was spent on anti-VEGF injections in the NHS in the month of January 2015, equivalent to £540 million per year. ranibizumab and aflibercept were used for the majority of injections If the NHS switched to bevacizumab only, this would represent a potential cost saving to the NHS of £539 million pounds per year (€690 million, $780 million)