The National Institute for Health and Care Excellence has issued final draft guidance recommending Novartis’ Lucentis (ranibizumab) as a treatment option for sight problems caused by new blood vessels growing at the back of the eye in people with pathological myopia, a rare form of short-sightedness.
The treatment should only be prescribed if Novartis makes it available to the NHS under terms agreed with the Department of Health as part of a patient access scheme (PAS), says NICE.
The independent appraisal committee examining Lucentis’ use in this indication has decided that an appraisal consultation document is not needed, so the recommendations could go straight to a final appraisal determination. However, NICE points out that it has not yet issued final guidance to the NHS, so this decision could change in the event of an appeal.
Pathological myopia is a chronic condition characterised by excessive lengthening of the eye and degenerative changes at the back of the eye. These changes can cause blood vessels to leak or bleed into the retina, in a process known as choroidal neovascularisation (CNV), and this can result in visual impairment, particularly a loss of central vision.
Current management of CNV aims to protect or improve clarity of vision, and the new final draft guidance recommends Lucentis as an option for treating visual impairment due to CNV secondary to pathological myopia.
Lucentis’ 10mg/ml list price is £742.17 per 0.23ml vial, excluding value-added tax. The appraisal committee agreed that Novartis’ base case analysis showed that the drug dominated verteporfin photodynamic therapy – ie, more effective and less costly – resulting in more quality-adjusted life years (QALYs), at 13.19 compared with 12.75, and lower costs, at £9,694 versus £12,455.
NICE chief executive Sir Andrew Dillon points out that CNV can cause sight problems such as distorted vision, colour disturbance and even sight loss, which can come on suddenly and may cause irreversible damage.
The appraisal committee’s conclusion that the recommendations can go straight to a final draft, without the need for public consultation, will speed up access to this treatment, he added.
Around 200,000 people in the UK have pathological myopia. While it is not known how many have CNV associated with pathological myopia, approximately 30% of people who develop CNV in one eye will develop it in the other eye within eight years, says NICE.