NICE may bless off-label Avastin use in eyes

The British cost-effectiveness watchdog poses trouble for Roche, but not for the usual reasons. The National Institute for Health and Clinical Excellence, the gatekeeper for prescription drug use by the National Health Service, is set to consider approving the cancer drug Avastin as a treatment for macular degeneration. And that would stymie Roche's attempts to keep Avastin from poaching on its eye drug Lucentis.

Genentech, a unit of Roche, developed Lucentis as a dedicated macular degeneration treatment. But ophthalmologists have been using Avastin as a much-cheaper substitute. At $150 per treatment versus Lucentis' $2,000, Avastin has been a boon for money-savers but has seriously hampered Lucentis' growth. The drugmaker has tried various strategies for holding Avastin off, including a much-maligned attempt to restrict distribution to pharmacists who supplied eye doctors.

The debate prompted the U.S. National Eye Institute to launch a head-to-head study of the two drugs. Early results are expected later this year. In the meantime, the always cost-conscious NICE is getting ready to appraise Avastin for eye use, even though it doesn't have official regulatory approval for that indication.

If NICE gives Avastin the thumbs-up, that would be the first official government approval of the drug for ophthalmic use. Could broader use in other locales--the U.S., for instance--be far behind?

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