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Macular Degeneration

Volume 456: debated on Tuesday 6 February 2007

2. What provision her Department has made for funding treatments for macular degeneration; and if she will make a statement. (118584)

All primary care trusts are funding photodynamic therapy for age-related macular degeneration in line with National Institute for Health and Clinical Excellence guidance. NICE is appraising Macugen and Lucentis for treating this condition and it expects to publish guidance in October.

I am sure that my right hon. Friend is aware that Macugen, an anti-vascular endothelial growth factor drug that can stop macular degeneration occurring in the eyes of elderly people, has already been approved in Scotland. As the increase of diabetes is likely to result in a vast increase in age-related macular degeneration, is it not time that the English authorities were allowed the same funding to give people the drug that is now available in Scotland?

My hon. Friend is right that the Scottish Medicines Consortium has approved Macugen since August, although it has not arrived at any decision on Lucentis. Its view will be superseded by NICE guidance when it is available. The important thing is that decisions on the cost and clinical effectiveness of new drugs should be made by independent clinical authorities, not by politicians, and that is precisely why we established NICE and back it in making its judgments.

The Secretary of State will be aware that 57 people start to lose their sight daily through this condition, and the average annual cost of support is £9,500. Given that these therapies are widely regarded as being very effective, is there not a case for fast-tracking the NICE decision so that fewer people go blind?

No patient should be refused Lucentis or Macugen simply because NICE guidance does not yet exist, but NICE needs to evaluate the new treatments thoroughly and it has decided, I think rightly, to evaluate them together so that the two treatments can be compared with each other as well as with the existing treatment. That means that it is taking a little longer, although it started on the evaluation before Lucentis was licensed, as it was only a couple of weeks ago. The guidance will be ready as fast as possible, consistent with arriving at a good, thorough and fair decision.

My right hon. Friend will know that wet AMD is also being treated at the moment on the NHS in some parts of the country by the use off-licence of a drug called Avastin that is licensed for the treatment of bowel cancer. When or if either of the drugs being appraised by NICE come into the marketplace with NICE’s approval, will Avastin still be available on the NHS if both the clinician and the patient believe that it should be?

My right hon. Friend has raised an extremely important point. As he has said, Avastin has not been licensed for use on macular degeneration, although it is being used by some clinicians with the support of the NHS. The problem is that the companies concerned—Genentech which manufactures it and Roche which distributes it in Europe—have not applied for a licence for its use on macular degeneration, and no clinical trials have been conducted for that purpose. At the moment, if a clinician wants to use Avastin and the patient is willing to have an unlicensed drug used, it is available on the clinician’s judgment, which will continue to be the case within the NHS. Although we cannot require the companies concerned to apply for a licence, in view of the very promising results that have been reported by a number of doctors, I urge both companies to initiate clinical trials for the use of Avastin for people with macular degeneration and to consider applying for a licence in the light of those trials.

What is the Secretary of State doing to ensure that people have the same opportunity to receive treatment for macular degeneration right across the country? In particular, Northern Ireland seems to be the last part of the United Kingdom to receive access to drugs, while others on the mainland benefit from them based on NICE guidelines.

Health is a devolved matter. At the moment, I understand that the health boards in Northern Ireland are not funding either Macugen or Lucentis. However, I am sure that they will want to take account of the NICE guidance, as soon as it becomes available.

On the basis that prevention is better than cure, will my right hon. Friend congratulate Simon Kelly’s team at the Royal Bolton hospital, which has established a firm link between AMD and smoking? Does she agree that we should get the message across to all smokers in the land to try to avoid incidences of that difficult condition?

My hon. Friend is absolutely right, and I readily congratulate that team on its excellent research. The introduction of smoke-free legislation later this year will be an important step forward in public health generally, and specifically in reducing the risk of other people acquiring that appalling condition in future. We will, of course, redouble our efforts to get across the message about the huge dangers involved in smoking for people of any age.

Does the Secretary of State agree that the cost of the drugs that can have a successful effect on people with conditions such as AMD are insignificant compared with the social costs of failing to treat such diseases?

The hon. Lady is right, because one has to look at the consequences for an individual and for social care and health services of a patient losing their sight. However, it really is not good enough for Conservative Members constantly to demand additional funding for new drugs, new treatments and additional services, when they have been wholly unwilling to support additional investment in the NHS—investment that we made and they voted against.

I think that the frightening thing is the speed with which the degeneration occurs—one of my constituents recently wrote to me about it. What are the Government doing to further research into vision and particularly into AMD? I welcome the Secretary of State’s statement on Lucentis today.

My hon. Friend has raised an extremely important point. Research on vision and on many medical conditions is the responsibility of the Medical Research Council, the funding for which we have significantly increased. I draw my hon. Friend’s attention to the review that we recently published of eye-care services, which emphasises the need to ensure that local primary care trusts get the best possible local eye-care services, with an emphasis on early diagnosis and better treatment in the community.

As we have heard, despite Macugen being approved by the Scottish Medicines Consortium, and Lucentis receiving its European licence, neither drug will be appraised by NICE until later this year. Given the real concern felt by many—in particular, the Royal National Institute of the Blind and people such as Alice Mahon—that cash-strapped PCTs are withholding funding, and given the fact that the Government are not assessing what proportion of patients recommended for such treatments are being turned away, which is something that my PCT is struggling to answer, what concrete assurances can the Secretary of State give that PCTs are following her instruction that funding should not be withheld purely on the grounds that NICE has not yet issued its guidance?

Just before Christmas, we reiterated guidance to the NHS that no patient should be refused Lucentis or Macugen, or indeed other treatments, simply because NICE guidance does not yet exist. Until NICE issues its guidance, as it will later this year, it is up to each primary care trust, whose professional executive is chaired by a clinician, to consider each case on an individual basis. The hon. Gentleman has to decide whether he supports NICE, which is widely regarded as a model around the world, or wants to go on undermining the outstanding and important work that it does.