Anti-VEGF therapy on the rise, fully reimbursable in France

PARIS — Age-related macular degeneration is increasingly treated by anti-VEGF therapy in France, where health authorities provide full reimbursement for what international multicenter trials and evidence-based medicine showed to be the best standard of care.

In an interview here at the French Society of Ophthalmology, Gabriel Coscas, MD, told Ocular Surgery News that a large investment has been made by the government to offer AMD patients the best medication currently available, namely Lucentis (ranibizumab, Genentech), despite the high costs involved.

"We have done the same for other ocular diseases, like cataract, and nobody would discuss the high cost of treating a patient for cancer," Dr. Coscas said. "So I don't see why anyone should be surprised at the amount of money that is spent on a drug that treats a severe and, unfortunately, increasing emergency like AMD. Verteporfin [photodynamic therapy], which didn't have results as good as those of the anti-VEGF therapy, was not less expensive than ranibizumab."

He also said no predetermined limits, but regular monitoring of the effects of the treatment, should decide the number and frequency of anti-VEGF injections.

"Patients must be followed closely and regularly examined using all the currently available technological equipment. This again requires investing money and time, but there is no other way doctors, politicians and a civilized society can deal with a condition that threatens the vision, functionality and quality of living of so many people," Dr. Coscas said.

Reimbursement is provided to patients for this standard of care in whatever specialized center, public or private, they are referred to.

Because of these provisions, the use of off-label drugs such as Avastin (bevacizumab, Genentech) is not an issue in France, he said.

"Bevacizumab has proven effective in small studies and seems to have no particular side effects, but there is no reason why we should offer to our patients a drug that has not been properly tested in international, multicenter, randomized clinical trials and that is not available in the dosage that is required for intraocular use, rather than another one that has undergone the regular process of validation. Particularly since it doesn't make any difference in terms of individual or institutional costs," Dr. Coscas said.

As far as PDT, he said its use as an adjunctive treatment is now limited to the cases that do not respond appropriately to anti-VEGF therapy alone.