Why have UK doctors been deterred from prescribing Avastin?

Despite widespread critical coverage in The BMJ and elsewhere, the dominance of expensive drug ranibizumab (Lucentis) over cheaper bevacizumab (Avastin) to treat wet age related macular degeneration (AMD) continues unabated in the UK.

New evidence uncovered by The BMJ raises questions about the legal and regulatory positions that have skewed clinical practice, fuelled drug costs for the NHS, and left doctors confused about what they can and can’t prescribe. But in recent weeks clinical leaders have begun to fight back. Over 100 clinical commissioning groups (CCGs) in England have written to the health secretary, NHS leaders, and the General Medical Council, urging a resolution. The current situation is “untenable,” they say. Allowing CCGs to use bevacizumab instead of ranibizumab could release £102m (€138m; $152m) a year for patient services.

The NHS spends £244m a year on ranibizumab, the second highest amount for any drug.1 However, research and development costs do not explain why ranibizumab is priced 10-20 times higher than bevacizumab, Philip Rosenfeld, professor of ophthalmology at the Bascom Palmer Eye Institute in Florida told The BMJ. He was involved in the early phase trials of ranibizumab and was one of those who pioneered the use of bevacizumab for wet AMD. He said bevacizumab is also more expensive to make than ranibizumab.

Ranibizumab is a monoclonal antibody fragment …