Anti-VEGF Agents for Wet AMD – Counting the Cost

Age-related macular degeneration (AMD) is the most common cause of loss of vision in older people in developed countries. There are two forms – “wet” and “dry”. The wet form is more serious; it affects about 10% of people with AMD. In this type, the blood vessels nourishing the macula start to multiply and leak blood and fluid, which can result in complete loss of central vision within a few months.

Recently there has been success treating wet AMD with substances called anti-vascular endothelial growth factor (anti-VEGF) agents, which block the growth of new blood vessels. Anti-VEGFs are given by injection into the eyeball (into the vitreous humor), every 4 to 6 weeks. One, pegaptanib (Macugen®), was approved in the USA in 2004. Another, ranibizumab (Lucentis®), which was approved in mid-2006, has been found to be extremely effective – “phenomenal” in some expert’s view.

Ranibizumab is expensive – around $2000 per dose, or $50,000 a year. It is, however, a close relative of another anti-VEGF, bevacizumab (Avastin®), which was approved in 2004 for treating colon cancer. Not surprisingly, many ophthalmologists have used bevacizumab “off-label” instead of ranibizumab, because of the cost difference; it should cost around $1500 a year. And the cheaper drug appears to be safe and effective, at least in the short term. The controversy over the best choice of anti-VEGF will continue until larger studies are completed for the candidates, including cost-benefit assessments.