New Treatment for Dry Geographic Atrophy Faces NHS Cost Hurdle
A recent study published in the esteemed journal Ophthalmology Retina has cast a spotlight on the financial implications of a groundbreaking treatment for dry Geographic Atrophy (GA), a progressive eye condition. The FDA-approved intravitreal pegcetacoplan, heralded as a significant advancement in ophthalmic medicine, is administered through monthly or bimonthly injections. However, its cost-effectiveness is currently under scrutiny, particularly in relation to the NHS's stringent value-for-money criteria.
The study reveals a nuanced understanding of the treatment's benefits versus its financial burden. While monthly injections show a marginally better outcome in slowing the progression of GA, the alternative, less frequent administration schedule, offers a slightly reduced benefit at a notably lower cost. This finding raises important questions about the optimal treatment regimen, balancing clinical efficacy with economic feasibility.
A critical aspect of the study is its focus on the quality-adjusted life year (QALY), a metric used by the National Institute for Health and Care Excellence (NICE) in the UK to assess the cost-effectiveness of medical treatments. Generally, a threshold of around £30,000 per QALY is used; treatments exceeding this value are often deemed not cost-effective for NHS use. The current pricing of intravitreal pegcetacoplan in the US, as the study points out, significantly surpasses this threshold, with estimated costs of $706,000 (for monthly treatments) and $397,000 (for bimonthly treatments) per QALY.
This pricing positions the drug well beyond the typical affordability range for the NHS. The hope lies in potential price negotiations that could bring the cost down to a level acceptable to NICE. However, this is complicated by the fact that the drug is yet to receive approval in the UK and Europe. The likelihood of its NHS adoption hinges not just on price negotiations but also on regulatory clearance.
The situation is in contrast for the treatments for Wet Macular Degeneration, which have been widely praised for their effectiveness in preventing severe vision loss. Unlike these 'wonder drugs,' the benefit-to-cost ratio of intravitreal pegcetacoplan for dry GA, as per current evaluations, appears less favourable.
As it stands, the introduction of intravitreal pegcetacoplan into the UK healthcare system faces significant hurdles. Its future hangs in the balance, contingent on both regulatory approval and a reevaluation of its cost-effectiveness. For patients suffering from dry Geographic Atrophy, this presents a waiting game, with the hope that advancements in treatment are both medically effective and economically viable for widespread NHS use.
Nicholas Lee 2024