June 19 2012 929376
Mr. R.E. Sleath
Chair, Access for Sight-Impaired Consumers (ASIC)
75 – 6600 Lucas Road
Richmond BC V7C 4T1
Dear Mr. Sleath:
Honourable Michael de Jong, QC, Minister of Health, has asked me to respond to your letter of May 17, 2012 regarding the Age-Related Macular Degeneration (AMD) Treatment Program in British Columbia.
Expansion of the program to cover bevacizumab (Avastin®) and ranibizumab (Lucentis) provides more options to enhance patient care and ensure the best treatment is available for every patient. BC retinal specialists have many years of experience using bevacizumab for AMD. Bevacizumab has also been prescribed extensively for wet AMD by retinal specialists throughout Canada and the world for several years.
The clinical evidence for supporting bevacizumab for AMD continues to grow. In April 2012, the National Eye Institute, one of the U.S. federal government’s National Institutes of Health (NIH) announced the second year results from an NIH funded head-to-head study comparing bevacizumab and ranibizumab which found that the drugs were equivalent in treating AMD. The results from this study were published in the New England Journal of Medicine.
Funding of drug use for off-label indication is common practice world-wide. Drugs are commonly used for off-label indications in virtually all areas in medicine. The American College of Physicians estimates that 21 percent of prescribed medications are used for non-approved indications, reaching 50 percent for widely prescribed cancer agents.
The Ministry of Health (the Ministry) remains comfortable with the use of bevacizumab in AMD. The Ministry is aware of the Health Canada warnings issued for bevacizumab use in AMD and continues to monitor as new information is available.
In answer to your question regarding physician remuneration, the AMD program fee does not favour the use of one drug over the other. The choice of drug to be used to treat AMD in a specific patient is made by the retinal specialist in discussion with their patient
Under the ANID program, retinal specialists are reimbursed the actual cost of the drug used as well as a program fee to cover their AMD program activities. Retinal specialist AMD program activities include developing clinical practice guidelines, monitoring program safety and effectiveness, implementing a provincial plan to ensure all centres have access to a retinal specialist and participating in program quality assurance and research activities.
I appreciate the opportunity to respond.
Assistant Deputy Minister
pc: Honourable Michael de Jong, QC