July 2, 2012
Minister Michael DeJong
BC Ministry of Health
Room 337 – Parliament Building
Victoria, BC V8V 1X4
Dear Minister DeJong:
We write to thank you and Ms. Walman for your response of June 19. However, we are very disappointed by the Ministry’s response with respect to the inclusion of Avastin in the province’s AMD Expansion Program.
Among factual errors about remuneration of retinal specialists contained in Ms. Walman’s letter, there is a significant amount of apparent deception related to the suitability of Avastin for injection into the eye.
For example, comparing the use of Avastin for AMD treatment to the off-label use of medicines to treat cancer is totally inappropriate. The treatment of cancer with off-label medicines has nothing to do with our member’s concerns about the use of Avastin in wet AMD. As you can appreciate, for some cancers, sometimes no other treatment choices are available except ‘experimental’ or ‘off-label’ drugs, and patients are facing their terminal conditions in the absence of treatment. This clearly bears no relationship to the use of an off-label drug in wet AMD or in any other disease or condition for which a properly researched and federally approved choice is available.
It appears that the only reason Avastin is being supported by your government is because it costs less than Lucentis. And, because Avastin costs less, your government is ignoring its own rules. The BC Liberal Government insists that all drugs must be approved by Health Canada before they can even apply to be covered under the Pharmacare program. Why does Avastin deserve a special exception that puts seniors at risk of losing their eyesight or places them in jeopardy of serious and potentially fatal side effects? It is our view the BC Liberal Government has allowed this exception simply because Avastin costs less.
Our members have significant concerns about the off-label use of Avastin for the treatment of AMD. Recent reports in credible and respected medical publications indicate that Avastin is not as safe as Lucentis, and Health Canada has issued warnings advising against Avastin’s use in the eye. We refer you to a report in last month’s Canadian Journal of Ophthalmology by Dr. Vijay Sharma of Queen’s University. Dr. Sharma has indicated that compared to Lucentis, patients treated with Avastin have a significantly greater chance of developing serious adverse eye inflammation and other reactions. Why is your government exposing BC seniors to this elevated and unnecessary risk?
Several other publications within the past year have also reported that Avastin may be responsible for more strokes, heart attacks, and other serious adverse reactions requiring hospitalization when used in the treatment of AMD. Among those studies is the research study published in the New England Medical Journal that Ms. Walman quoted as a justification for funding Avastin. The National Institute of Health’s study showed significantly more serious side effects requiring hospitalisation caused by Avastin than with Lucentis.
No doubt you are aware that ASIC has recently applied under the Freedom of Information Act for details related to the AMD Expansion Program to ascertain the details of the agreement between your government and the doctors. Even though Ms. Walman’s reply to our last letter states there is no connection between physician remuneration and the choice of drug, the facts do not support her statement. Section 26.b of the agreement indicates that if the AMD program budget is exceeded, doctor’s fees will be reduced. It is very clear that this agreement motivates doctors to use Avastin, the cheaper drug, thereby adding significant benefit to their personal remuneration under the program.
Is Avastin supported by the doctors because they are getting paid an extra $300 per treatment over and above their regular billing fee? Are other doctors such as BC’s anesthesiologists aware of this? Why are doctors in BC getting an MSP fee for this service of $135.81 plus an extra $300 fee for a total of $431.85 per treatment when an article in the Toronto Star on May 7th has stated the Ontario government will be lowering the fees paid for this treatment from $189 to $90?
The bottom line clearly supports the fact that your government is causing doctors to choose a drug that has not been approved, is off-label, and is shown to be less safe than a drug which is approved, is shown to be safer, produces better results, and costs more.
Ms. Walman’s letter also states that the BC Government wants to “ensure the best treatment is available for every patient”. Her response to our letter indicates that the retinal specialists have developed ‘clinical practice guidelines’ for the use of Avastin in AMD. The details of the AMD Expansion Program that we have obtained through Freedom of Information states the same. Evidence-based guidelines for many conditions are posted on both the government’s and the BCMA websites. Would you please explain why the AMD Treatment Guidelines are not posted on these web sites as well?
As a Cabinet Minister in an “open government”, we are requesting that you provide us with a copy of the clinical practice guidelines for AMD treatment. We are sure you will concur that when considering the risks associated with Avastin use, it is important for all wet AMD patients to understand exactly who will be receiving treatment with the properly approved drug Lucentis and who will be at risk for potentially significant side effects with Avastin.
Looking forward to your earliest response, I remain