Following the national procurement for medical retinal vascular medicines, NHS England has published an operational note on Commissioning recommendations. This followed discussions with various stakeholders, including members of The Royal College of Ophthalmologists. It introduces the use of ranibizumab biosimilars alongside available intravitreal anti-VEGF agents and steroids in the treatment algorithms for wet age-related macular degeneration, myopic choroidal neovascularisation, diabetic macular oedema and macular oedema due to central and branch retinal vein occlusions.
Eyecare is the highest volume outpatient speciality within the NHS, and the medicines used for medical retinal vascular conditions account for some of the highest cost and volume treatments used in secondary care. With increasing life expectancy and an ageing population, the NHS expects that demand for medical retinal vascular treatments will continue to increase as more patients with eye disease are diagnosed and treated.
Through consistently using the most clinically appropriate and cost-effective treatments and ensuring that patients receiving treatment are responding, efficiencies can be driven to support recovery and transformation in eye care services. This will create capacity so that patients can be seen in a timely manner and avoid deterioration of vision, in line with the recommendations of the NHS England National Eye Care Recovery and Transformation Programme.
The Royal College of Ophthalmologists encourages all ophthalmic clinicians to discuss the contents of this operational note with their Trust and local commissioners.
Clinicians and patients should determine together which treatment is clinically appropriate for an individual based upon the specific needs of the patient and relevant NICE technology appraisal guidance. These commissioning recommendations do not restrict a clinician’s ability to make the most appropriate decision for an individual patient through shared decision-making, taking into account the patient’s needs and wishes.
Reviewing existing treatment, considering alternatives, counselling and consenting patients to change to a different treatment will require additional time. Ophthalmic services will need to agree with their commissioners on the optimal approach for implementing the commissioning recommendations, balancing the needs of the patients and resources available.
The Specialist Pharmacy Service has developed a patient information sheet on Ranibizumab biosimilar that you may wish to refer to.
Read The RCOphth Commissioning Guidance on Age-Related Macular Degeneration Services.