Costly Eye Drug Challenged by Inexpensive Alternative

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A new drug for degenerative eye condition was approved last month by the Food and Drug Administration. It will cost about $2,000 per injection. But a vastly cheaper alternative for treating macular degeneration is said to have the same effect. But it does not have FDA approval as a treatment for the eye condition.

RENEE MONTAGNE, host:

Now, a look at two drugs. Doctors use each to treat the leading cause of blindness, called wet macular degeneration. One drug costs only $20 to $50 a dose - the other, nearly $2,000.

NPR's Joseph Shapiro has more.

JOSEPH SHAPIRO reporting:

At a medical conference last July, Dr. Philip Rosenfeld reported on the strange thing he was doing with a drug to treat colon cancer. He was injecting it into the eyeballs of patients who are going blind. Other retina specialists in the audience knew that usually, there was little they could do to help older patients with wet macular degeneration. But Rosenfeld's data showed the cancer drug stopped vision loss, and in many cases gave patients vision back. It had worked from the very first patient.

Dr. PHILIP ROSENFELD: In that first patient, we had a dramatic change in the back of the eye. The fluid and the blood vessels stopped growing and leaking. The retina assumed a more normal anatomic contour. She received one injection, and she remained stable for over eight months. And gradually, her vision got better.

SHAPIRO: The cancer drug is called Avastin, and Rosenfeld knew it was almost identical in molecular structure to another drug called Lucentis. Both used a clever design to stop a protein that causes the uncontrolled growth of blood vessels. Rosenfeld knew this because he was helping the drug company test Lucentis. It was specifically for wet macular degeneration and very promising, but it was months, or even years from getting on the market. Rosenfeld had patients at Bascom Palmer Eye Institute in Miami who couldn't wait. Every day, they were losing the little vision they had left.

Dr. ROSENFELD: They were desperate, and we were desperate to help them.

SHAPIRO: As a cancer drug, Avastin is expensive - about $2,200 a dose. But to inject it into the eye, Rosenfeld needed just a tiny amount, and that was cheap.

Dr. ROSENFELD: When Avastin is prepared in a commercial pharmacy, the price can range from $17 a dose to $50 a dose.

SHAPIRO: Many doctors who heard Rosenfeld talk went home and started giving their patients Avastin. That worried Genentech, the company that makes both Avastin and Lucentis. Because only Lucentis, the new drug, was designed to work safely in eyes.

Genentech asked the Food and Drug Administration to speed up its review. In June, the FDA approved Lucentis. Genentech started shipping it right away and set the price.

Mr. MICHAEL JOHNSRUD (Health Economist, Center for Pharmoeconomic Studies, University of Texas): $1,950 a dose, and multiple doses may have to be given over the course of one or two years.

SHAPIRO: That Michael Johnsrud. He's a health economist at the Center for Pharmacoeconomic Studies at the University of Texas. Johnsrud says when it came time to set the price, Genentech didn't compare Lucentis to its sister drug, Avastin.

Mr. JOHNSRUD: A big determining factor is what other drugs are out there? What's the alternative? What are drugs that are in the market currently priced at?

SHAPIRO: Two other drugs were being sold. The better of the two older ones cost $1,000, and Lucentis was a pretty big improvement. About 40 percent of people get a lot of vision back, maybe enough to even get in the car and drive again.

Mr. JOHNSRUD: So $1,950 compared to about $1,000 - that might be a reasonable price to expect from a drug that appears to provide quite a bit of additional benefit.

SHAPIRO: Officials at Genentech say they priced the drug so that patients could get it. Dr. Sue Hellmann is president for product development.

Dr. SUE HELLMANN (President, Product Development, Genentech): Very, very importantly, whenever we set price, we spend the most time on patients having access. So will they have insurance coverage? What will be the cost to patients?

SHAPIRO: Hellmann says what patients will pay out of their own pockets is pretty much the same for Lucentis or Avastin.

Dr. HELLMANN: We knew that when we launched Lucentis, our estimate was that the average Lucentis monthly co-pay out of pocket would be less than $50 per patient.

SHAPIRO: Hellmann says that insurance will pick up almost all the cost of the high-priced Lucentis. Most patients have Medicare. Many have extra private insurance. And Genentech set up its own charitable foundation for those who still need help. That might make Lucentis the obvious choice. It's the one found safe for use in the eyes. It's the one covered by insurance. But healthcare isn't that simple.

Dr. REGINALD SANDERS (Ophthalmologist): So, Mrs. Smith, let me talk to you about - I think you're now ready to use on the newer drugs. And there are two drugs - Avastin and Lucentis - that I think are kind of state-of-art treatment for…

SHAPIRO: In an exam room in Chevy Chase, Maryland, ophthalmologist Reginald Sanders is telling a patient about the two drugs.

Dr. SANDERS: Some people feel like they want to have a FDA-approved drug, and they have the financial resources to pay the 2,000 every month. That's their prerogative. They can do that. If you don't have the resources to pay $2,000 every month, I would use Avastin. I think clearly, Avastin's a better value. Okay.

Mrs. JANICE SMITH (Patient): I'll use Avastin.

SHAPIRO: Dr. Sanders is a partner in a big private practice. Right now, his patients have to right out a check for each dose of Lucentis, and then submit the bill to their insurance and wait for reimbursement. That's an issue for his patient today, Janice Smith, and her son Richard who gives advice.

Mr. RICHARD SMITH (Patient's Son): I'd rather see your 2,000 a month go to care for you at home as opposed to just buying an FDA-approved drug.

SHAPIRO: The mother has Medicare. She has private insurance. She lives at home with a help of aides.

Ms. SMITH: It's nice to have your eyes. I mean, I do want to see.

SHAPIRO: And in the end, mother and son decide they need the cash flow to pay the aides. She decides to start on Avastin.

Joseph Shapiro, NPR News.

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