Professor Alan Maynard OBE, HPI's esteemed columnist, reflects on the blinding stupidity of currently prevalent NHS treatment of 'wet AMD'.

For several years, it has been known that there are alternative treatments for ‘wet’ age-related macular degeneration (AMD): Lucentis and Avastin. The former costs some £700 per dose; the later can be obtained for less than one-tenth of this high cost.

Lucentis is registered for the treatment of macular degeneration. Avastin is not licensed for macular degeneration. Both drugs were created by the same company, Genentech.

Clearly, it is not financial advantageous for Genentech to have Avastin licensed for the treatment of patients going blind, as it would destroy the market for Lucentis.

Lucentis treatment, following NICE guidance, is provided by the NHS. No randomised clinical trial of Avastin has been completed to show its equivalent effects to Lucentis - although such evidence as there is shows that they work to similar effect, as noted in the Wall Street Journal in February 2007. BBC News Online picked up the story in August 2008.

A drug such as Avastin can be used ‘off-license’ if clinicians consider it clinically appropriate. There is considerable anecdotal evidence of privately practicing clinicians using Avastin.

The Macular Degeneration Society website states that “the NHS is putting substantial funding into a clinical trial which will compare Lucentis with Avastin. About 25 hospitals are involved in the trial and they will be monitoring the effectiveness and dosage regime of about 20-30 patients at each of the trial centres over a 2 year period. The trial is called IVAN. More details may be found on the trial website".

The IVAN trial website states that “The IVAN trial is funded by the Health Technology Assessment (HTA) Clinical Trials programme of the UK National Institute for Health Research (NIHR)”. It also features some highly reasonable responses to criticisms.

In a time of recession, is it reasonable that the NHS pays such a high price to bring sight to patients going blind? Why is this situation tolerated?