Medicare Urged to Consider Avastin for Eye Treatments, Despite Infection Risk

<"">Avastin could soon become Medicare’s drug-of-choice for treating wet, age-related macular degeneration, even though it has been associated with serious eye infections when used this way. Moving from Lucentis to Avastin would allow Medicare to save half a billion dollars a year, according to a report from The Tennessean.

Avastin is actually a cancer drug, and using it to treat wet, age-related macular degeneration is an off-label use of the drug. Both Avastin and Lucentis are made by Genentech and work in a similar way. But while Avastin only cost around $50/dose, Lucentis comes in around $2,000/dose. Avastin, however, is sold in larger doses, so in order to be used for eye injections, it must be divided into smaller vials. During this dividing, which is usually done by a compounding pharmacy, bacterial contamination can occur.

In the past several months, at least 21 people sustained serious eye infections – some of which were blinding – following treatment with Avastin for wet, age-related macular degeneration. According to an alert issued by the U.S. Food & Drug Administration (FDA) in August, 12 such infections occurred among people in the Miami, Florida, area. Shortly after that, it as learned that four other people had sustained such infections following Avastin injections through the Tennessee Valley Healthcare System, part of the United States Department of Veterans Affairs. Five were also reported among people who received Avastin eye injections at the Veterans Affairs medical center in Los Angeles.

A week after the FDA issued an alert regarding outbreaks of Avastin-related eye infections, the Office of Inspector General recommended that Medicare look at how much money could be saved if it reimbursed at the Avastin rate, The Tennessean reported. According to the Inspector General, between 2008 and 2009, Medicare spent $40 million on Avastin treatments for just under a million people. Lucentis treatments for less than 700,000 patients amounted to $1.1 billion.

The Tennessean pointed out that a comprehensive comparison of Lucentis and Avastin published this year in The New England Journal of Medicine determined that the cheaper drug is equally effective. But Genentech, which obviously has a financial stake here, says this is not the case, and that the two drugs were created for different purposes.

“Genentech scientists engineered Lucentis with consideration of the limited space available in the eye,” a company spokesperson told the Tennessean. “Lucentis was designed to bind more tightly to its target. It binds more than tenfold more tightly than does Avastin.”

The spokesperson also noted the potential for contamination when Avastin is split into single-shot doses.

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