The BMJ Today: Keeping costs down

kellyResearchers have calculated that billions of dollars could be saved if all eye doctors in the United States used the less expensive option of two drugs (bevacizumab and ranibizumab), which are commonly used to treat neovascular age related macular degeneration and diabetic macular oedema. The conditions affect more than two million Americans, yet only one of the drugs, ranibizumab (marketed under the name Lucentis), has been approved by the Food and Drug Administration for treatment. The other drug, bevacizumab (marketed as Avastin), is approved as an anticancer drug, but is used by ophthalmologists “off label.”

At $2023 (£1200; €1500) a dose, ranibizumab is 40 times as expensive as off-label use of bevacizumab, which costs just $55 a dose. With maintenance treatment often requiring as many as 12 injections a year, it is easy to see how costs can quickly escalate. Writing in the journal Health Affairs, the researchers calculate that the savings could amount to almost $29bn over the period from 2010 to 2020.

This is a “lesson,” say the researchers, which should steer US policy makers towards the use of bevacizumab—an “easy target for cost savings.” However, with previous studies having already vouched for the effectiveness of bevacizumab, this lesson doesn’t seem to be sinking in.

Here in England, cost effectiveness is measured by the National Institute for Health and Care Excellence (NICE), who last week issued new guidance on the management of atrial fibrillation. The last guidelines came out in 2006, and since then there have been some new developments. Most notable among them, is the recommendation that almost all patients with atrial fibrillation should be offered anticoagulant therapy to prevent stroke. In contrast to NICE’s 2006 recommendations, which focused on identifying the 45% patients at the greatest risk of stroke, doctors should now try to identify the 6-10% of patients at the lowest risk of stroke and offer anticoagulation to the rest. The BMJ was present at the press conference that was held to announce the guidelines, and reports on the story here.

NICE has its work cut out when it comes to addressing many of the growing health challenges in England. Yet when it came to its recent recommendations on weight management for overweight and obese adults, Simon Capewell, a professor of public health and policy at the University of Liverpool, was unimpressed. “On this sad occasion, the key recommendations simultaneously challenge common sense, science, democracy, public health, bread, and taxpayers.” He lays out his case in this blog.

Kelly Brendel is assistant web editor, The BMJ.