Published in the Edmonton Journal
September 30, 2015
The Alberta government says it will save up to $46 million over the next three years by treating more cases of retinal disease with a cheaper drug that has not been approved for eye injections by Health Canada.
While critics warned that Avastin’s side effects and long-term health impacts have been insufficiently researched, Health Minister Sarah Hoffman insisted she had no concerns about the drug’s “off label” status.
She and Edmonton retina specialist Dr. Matthew Tennant said some Alberta doctors have been using Avastin safely and effectively for close to a decade to slow the progress of age-related macular degeneration, and other conditions such as diabetic macular edema and retinal vein occlusion.
The drug has not been covered by the government, but that will change Thursday when the province launches a three-year pilot project. Patients in the program will be allowed to choose between Avastin and Lucentis, a drug that does have Health Canada approval but is also much more expensive at $1,575 a vial.
Avastin, which is actually designated as a treatment for various cancers, costs between $13 and $50 per dose.
Despite the price disparity, Tennant said evidence shows Avastin and Lucentis are equally effective. In the case of the “wet” form of macular degeneration, the drugs shrink unwanted and leaky blood vessels that can damage retinal cells. Patients often need monthly injections when the blood vessels return.
“I think it’s unreasonable to expect, when you know two products are equally as effective and believed to be equally as safe, that you would use one that is 100 times more expensive than the other,” said Tennant, adding that he has been working to get the program approved for seven years.
Hoffman said about 7,000 Albertans will be eligible for the program, including up to 1,000 patients who are currently going without medication. Participants will not face any co-payment, which could save seniors up to $300 a year. Data will be collected on the effectiveness of the medications.
Hoffman said Alberta is the seventh jurisdiction in Canada to start covering Avastin for eye treatments.
In B.C., there have been complaints the system doesn’t offer true choice to patients because the government has demanded Avastin be used 80 per cent of the time. As well, B.C. physicians can make more money by using Avastin, prompting concerns some doctors may push that drug on patients without giving them all the information.
Tennant said the Alberta program hasn’t yet set a quota for Avastin versus Lucentis, but that could come after experts review the first six months of usage patterns. Unlike B.C., he said Alberta doctors have no financial incentives to pick one drug over the other. No matter which medication is chosen, doctors will be paid $104 per injection, which covers the costs of their research contributions and properly preparing the drug for injection, he said.
Lucentis and Avastin are both made by Swiss-based company Roche. Avastin remains unapproved by Health Canada because Roche has never applied for approval, preferring to have its more expensive product used, Hoffman said.
Louise Gillis, national president of the Canadian Council of the Blind, said there are still too many unknowns about unintended health effects of Avastin. A 2011 alert from Health Canada noted the potential for various side effects, including inflammation that in rare cases could lead to permanent blindness.
“Many patients don’t have the expertise to understand what off-label really means,” Gillis said.