Welsh Government to fund NICE-approved eye medicine

This decision, published in a statement about the Treatment of Wet Age Related Macular Degeneration, comes just days after the 90-day deadline to implement the positive recommendation from the National Institute for Health and Care Excellence (NICE) that aflibercept should be used for the treatment of wAMD in England and Wales.(2) Aflibercept’s every other month dosing (after three initial monthly doses), without the need for monthly monitoring, means that it could help alleviate capacity issues in eye clinics as the number of patients with wAMD continues to rise year on year.(3–5)

Commenting on the announcement, Mr Sanjiv Banerjee, Consultant in Ophthalmology, University Hospital Wales said, “It is great news that we are now able to offer Eylea to our wet AMD patients as it could potentially help us to reduce the number of hospital visits for most people, which would relieve the huge pressure on eye services in Wales which has been rapidly increasing as the elderly population grows. Having central funding available means all patients across Wales will have access to the same treatment and quality of care, as funding will not have to be made available at a local level, preventing a postcode lottery.”

wAMD is a disease of the elderly(6) and  with 10 million people in the UK being over 65 years old the numbers are set to increase.(7) The latest projections are that there will be 5½ million more elderly people in 20 years time and the number will have nearly doubled to around 19 million by 2050.(7)

A recent study published in the British Journal of Ophthalmology states that approximately 40,000 people are newly diagnosed with wAMD each year in the UK(5) and current estimates predict that there will be more than 450,000 people with the condition by 2015.(8) If left untreated, or inadequately treated, wAMD is the most common cause of blindness in the western world.(9,10) Advances in wAMD treatment have gone a long way to improve the vision of people with wAMD in recent years, but the need for monthly hospital visits means that fewer than 50% of eye clinics are able to meet waiting times for the first injection(11) and 80% are failing to achieve the four week follow up time required.(11)

The decision from the Minister for Health and Social Services to make central Government funding available for aflibercept will mean that Local Health Boards (LHB) will not be required to make funding available for this treatment. This means all eligible wAMD patients will have equal access to aflibercept, guaranteeing the same quality of care across Wales.

In a statement Ceri Jackson, Director of RNIB Cymru said, ‘We welcome the news that Welsh Government has approved funding the use of a further drug to treat the biggest cause of sight loss in the UK.’ She went on to say that, ‘Some people do not respond to the currently available treatment, so having the option to have Eylea could mean the difference between saving and losing sight. For some patients the use of Eylea could also result in fewer visits to hospital, which is not only a benefit to patients but can help free up clinic time for staff to treat others.’

wAMD distorts central vision, making it blurry with straight lines appearing crooked or wavy. Over time, it may cause a blank patch in central vision.(6) If left untreated or inadequately treated, it can lead to blindness in as little as three months.(12)

The impact on a person’s quality of life can be seriously affected by wAMD.(13) Simple things that are taken for granted such as recognising faces and daily activities such as driving, reading, watching television, preparing meals and using the telephone become almost impossible.(13) With early diagnosis and rapid treatment however, people have the best chance of delaying the progression and preventing permanent damage.(14)

An investigation by University College London revealed that two thirds of older people with poor vision or registered blind report a ‘bad’ quality of life.(15) A further study also found that older people with poor vision are three times more likely to suffer with depression compared to those with good vision.(16)

All eligible wAMD patients in England and Wales will now have access to aflibercept on the NHS. The Scottish Medicines Consortium (SMC) has already accepted aflibercept for use within NHS Scotland for the treatment of wAMD.(17)

1. Government. Treatment of Wet Age Related Macular Degeneration statement. 30th October 2013
2. National Institute for Health and Care Excellence. Technology Appraisal 294. Aflibercept solution for injection for treating wet age related macular degeneration. July 2013
3. Eylea® (VEGF Trap-Eye) summary of product characteristics (SmPC)
4. Heier JS, et al. IntravitrealAflibercept (VEGF Trap-Eye) in Wet Age-Related Macular Degeneration. Ophthalmology 2012;119:2537-2548.
5.  Owen CG et al. The estimated prevalence and incidence of late stage age related macular degeneration in the UK. Br J Opthalmol. 2012
6. RNIB. Age-related macular degeneration. Available at: www.rnib.org.uk/eyehealth/eyeconditions/conditionsac/Pages/amd.aspx. (Last accessed: October 2012)
7. Cracknall R. The ageing population.Key issues for the new Parliament 2010. House of Commons library research. 2007. Available at: http://www.parliament.uk/business/publications/research/key-issues-for-the-new-parliament/value-for-money-in-public-services/the-ageing-population (Last accessed: July 2013)
8. Minassian D et al. Modelling the prevalence of age-related macular degeneration (2010–2020) in the UK: expected impact of anti-vascular endothelial growth factor (VEGF) therapy. Br J Ophthalmol. 2011;95(10):1433-1436
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11. Vision 2020. Macular Interest Group. wAMD clinics – survey. Available at: https://www.surveymonkey.com/sr.aspx?sm=2IdxU2xQhIgm1ZZRmuGl_2flqRbIdKfMGxD6D4gTFDOZU_3d (Last access: 22.07.13)
12. AMD Alliance International. Increasing the understanding of Wet Age-related Macular Degeneration (AMD) as a Chronic Disease. April 2011.
13. Mitchell J, Bradley C. Quality of life age-related macular degeneration: a review of the literature. Health Qual Life Outcomes. 2006;4:97
14. US National Eye Institute. National Institutes of Health. Facts about age-related macular degeneration. Available at: www.nei.nih.gov/health/maculardegen/armd_facts.asp#2) (Last accessed: October 2012)
15. UCL research for Thomas Pocklington Trust. An investigation of the circumstances of older people with sight loss: analysis of the English Longitudinal Study of Ageing., October 2006
16. Evans JR, Fletcher AE, Wormald RPL. ‘Depression and Anxiety in Visually Impaired Older People’, Ophthalmology vol. 114, 283 – 288, 2007
17. Scottish Medicines Consortium. aflibercept 40mg/mL solution for intravitreal injection (Eylea®) SMC No. (857/13). Available at: www.scottishmedicines.org.uk
18. Heier J. Retinal Physician 2009. Available at http://www.retinalphysician.com/articleviewer.aspx?articleid=102898 (Last accessed: October 2012)
19. Lucentis® (ranibizumab) summary of product characteristics (SmPC)
20. Amoaku. The Royal College of Ophthalmologists: Maximising Capacity in AMD Services 2009.
21. Harding SP. Neovascular age-related macular degeneration: decision making and optimal management. Eye. 2010;24:497–505