A Lottery Without Gambling

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Many people play the national lottery every week but very few win the jackpot. However, the incentive of the life-changing amount of money is enough to make people play.

Imagine if a new lottery was developed, where out of all the population, only 48% had access to the game, where the jackpot win could only be won if you lived in a certain county.

Imagine if the achievable jackpot was the only chance of a stable life but you are unable to win the jackpot because you live on the wrong street, whereas your best friend who lives round the corner has access to the lottery.

Unfair?

Definitely… but it’s occurring with the administration of Lucentis and Avastin on the NHS.

Lucentis, Macugen and Avastin are the new Anti-VEGF drugs used to try and treat wet age related macular degeneration. Originally developed to treat colorectal cancer, Avastin is used by 10% of eligible patients and is not licensed for treating AMD. Lucentis and Macugen are modified molecules of Avastin and are licensed for treatment of AMD but, not financed by every primary care trust. The drugs work by targeting VEGF (vascular endothelial growth factor) that is believed to cause neovascularisation in the macula. The drugs are administered by injection into the eye.

The Royal College of Ophthalmologists estimates that Lucentis costs £1700 per month per patient whereas Avastin costs £600. This equates to a £500million saving if Avastin were licensed for the treatment.

So why should a postcode lottery exist?

In an ideal world every patient would receive whatever treatment is needed. We know however, this doesn’t happen, not only with treatments for Macular Degeneration but also with many other diseases.

Unfortunately, the NHS has to be viewed as a business. The NHS does not have a bottomless pot of money to spend, so prioritisation of treatments has to occur. The NHS uses NICE (National Institute for Health and Clinical Excellence) to evaluate new treatments as to their cost effectiveness. The NHS could have more financing but that would probably result in higher taxes or national insurance contributions, something that nobody likes to see.

It is said that pharmaceutical companies make “extortionate profits�. This is unjust when you consider the cost of research, development and trialling of new drugs is estimated at $802 million! However, maybe if pharmaceutical companies worked in conjunction with NICE, by licensing alternative drugs, more would be approved for treatment and thereby research costs recouped. Roche commented that Avastin was not licensed for use to treat AMD for the following reasons:

• Avastin has not been tested for it’s safety upon the eye
• The current Avastin formulation has not been designed to have the osmotic behaviour an ocular drug may require
• For AMD, Avastin would need to be reformulated and produced in single dose vials to minimise the chances of infection, a requirement of the British Pharmacopoeia

With these factors taken into account it is estimated that the true cost of Avastin being developed for ophthalmic use would rise above the £600 quoted by the Royal College of Ophthalmologists.

Managing healthcare is an enormously complex and difficult task, especially when so many lives can depend on one decision. It seems that postcode lotteries will continue for much longer as patients demand much more from the NHS but are not always willing to pay for it. It is always a fear that the healthcare in Britain could change in its structure with many people looking at other countries and their systems. Do we really want an insurance system like in America where only basic treatment is offered to those with less financial security?

Where will the future take us, no one can really say, but it is clear that as budget and balance sheets get further stretched, funding to some healthcare services will continue to fall. Maybe it is time to consider a complete overhaul of funding for the NHS. It seems such a shame to have access to modern medicine and be unable to use them, for if you were the person who’s life would be changed by the inaccessible treatment the lottery would seem very unfair.

Read the Press releases from the Royal College of Opthalmologists here.

Read about the Royal National institute of Blind People Anti-VEGF Campaign here.

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