NCPA - National Center for Policy Analysis

Avastin vs. Lucentis: One Step Closer to Cost Rationing?

November 16, 2010

One of the many concerns about President Obama's health care legislation is that it will encourage -- if not eventually require -- the government to approve the cheapest rather than the best medical therapy, says Merrill Matthews, a resident scholar with the Institute for Policy Innovation.

Take the current debate over Avastin and Lucentis -- two drugs owned by San Francisco-based Genentech.

  • Avastin, a biologic approved for various types of cancer, was in the headlines recently because the U.S. Food and Drug Administration (FDA) was considering removing its approval to treat breast cancer because of concerns that the benefits didn't outweigh the risks.
  • Because Avastin is an FDA-approved drug, eye specialists have been using it "off-label" (i.e., for a condition it isn't approved for) to treat age-related macular degeneration (AMD).
  • Even though some doctors have been using Avastin to treat age-related macular degeneration, Genentech developed and received FDA approval in 2006 for Lucentis, a new drug specifically designed for that disease.
  • However, Lucentis is much more expensive than the non-AMD approved Avastin, and that raises concerns about the poor and uninsured.

Since age-related macular degeneration primarily affects the elderly covered by Medicare, the government has a financial stake in the decision over which drug to use.

The government's growing quest to control exploding health care costs is also why some think President Obama insisted on including what's called comparative effectiveness research in his health care bill.

When the government is the primary payer, budgets are tight and benefits have been overpromised, the lines between cost and quality can get blurred.  And with the massive new role ObamaCare will play both in determining coverage and financing of care, cost considerations won't be just an afterthought, they will be the primary goal, says Matthews.

Source: Merrill Matthews, "Avastin vs. Lucentis: One Step Closer to Cost Rationing?" Forbes, November 11, 2010.

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