Challenge
12 NHS CCGs across the North East and North Cumbria decided to offer patients with wet age-related macular degeneration (AMD) a choice of clinically-effective alternative drugs for their treatment. Avastin was available to treat wet AMD, and was a much cheaper alternative to the main drugs being used.Avastin is widely used across the world in the treatment of wet AMD, as well as being commonly used in private practice in the UK. There is a substantial body of evidence, including guidance from the National Institute for Health and Care Excellence (NICE), showing that it is as clinically safe and effective as the alternatives Lucentis and Eylea as a treatment for this condition.
Avastin is around 20 times cheaper than the most expensive alternative.
Pharmaceutical companies Bayer and Novartis who produce the alternative, more expensive drugs to treat wet AMD took legal
action, claiming it would breach a patient’s legal right to an approved drug.
Tasks
NECS provided medicines optimisation support to a series of Avastin steering group meetings. The case revolved around pharmaceutical issues, so experienced pharmaceutical support was critical to the success of the judicial review.
Attendance at the senior pharmacy managers meeting took place, along with several meetings with the chief pharmacist at City Hospitals Sunderland to try to improve engagement with this key group.
NECS developed a way in which the policy could be implemented lawfully, along with a witness statement for the high court explaining this and other points. Several teleconferences took place with the legal team. The NECS Medicines Optimisation team liaised with key contacts across the country to prepare for implementation (Specialist Pharmacy Services, Regional Quality Assurance Pharmacist, NICE, a Chief Pharmacist in Liverpool who supplies Avastin) During the judicial review, NECS were asked a range of testing questions that the pharmaceutical companies posed. NECS were able to relay these to our legal team to counter the argument of the pharmaceutical companies and our staff members’ expert medicines information skills were vital in this task.
NECS provided communications support to publicise the positive result of the judicial review in regional media and worked with our PR agency regarding national/international media.
NECS continuously monitor high cost drug expenditure and produce a quarterly report which includes the drugs for wet
AMD, demonstrating potential savings.
The drug is undeniably equally effective and much less expensive, and the money this will save – in excess of £13.5 million per year for the 12 CCGs involved in the litigation alone and hundreds of millions of pounds across the country – can be ploughed straight back into delivering the very best care possible to our patients. Here in the North, that’s enough to pay for an extra 270 nurses or 266 heart transplants every year, and in a financially stretched NHS that could be life changing for thousands of our patients.
Dr David Hambleton, NHS South Tyneside CCG Chief Officer
Results
In September 2018, the CCGs won the legal battle to offer Avastin to patients.
The new policy will now save the region’s NHS up to £13.5 million a year within the next five years. To put that in perspective, £13.5 million could pay for an extra 270 nurses or 266 heart transplants – every year. In a financially stretched NHS, that could be life-changing for thousands of our patients. NECS provided communications support to publicise the positive result of the judicial review.
The potential national savings of hundreds of millions of pounds can in the future therefore be redirected into vital resources and treatments.
The focus now moves towards implementation of the policy across the region, with all the benefits that this can bring for patients, clinicians and the wider NHS.
A first discussion on the practicalities of implementation will take place in Autumn 2018, and will include issues around securing supply of the drug and options to standardise patient-facing materials, as well as the opportunity to arrange legal briefings for clinicians and pharmacists.
The regional Avastin steering group, chaired by Dr David Hambleton, is ready to support and work with hospital trusts on this matter.