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Canwest News Service
Provincial health officials will meet today to decide whether to change the way government pays for the treatment of a serious eye disease in seniors.
On June 1, B.C.'s Medical Services Plan began covering both Avastin and Lucentis, two drugs used to treat the wet form of age-related macular degeneration (AMD), the leading cause of blindness among the elderly.
The plan sparked controversy because retinal specialists are being paid $530 per treatment, regardless of which drug they use. This became an issue because the costs of the two drugs are very different.
On Tuesday, Health Services Minister Kevin Falcon said that after administration and other expenses, it costs doctors about $345 per injection for Avastin, and $715 for Lucentis. This means, he said, that doctors lose money on one drug, but make it back on the other.
"You've got to have a fee schedule which fairly recognizes that where they will lose [money] in providing the appropriate medical treatment — i.e. using Lucentis — to some of their clients, they also, on using the Avastin for some of their other clients, will receive extra," he said.
Falcon said officials had projected that under the fixed rate of $530, doctors would on average use the two drugs evenly.
Since the program began, however, doctors have been using Avastin — the cheaper drug — 68 per cent of the time.
Falcon said there have been 6,330 injections between June 1 and Oct. 5. Of those, roughly 4,300 were of Avastin, and 2,000 were Lucentis.
Falcon said his staff meet today with retinal specialists and the Provincial Health Services Authority to analyse the data and determine whether the fee structure needs to be changed.
Falcon warned, however, against jumping to the conclusion that doctors have been making drug choices based on money.
"I really don't believe they would make decisions predicated just on financial incentives."
New Democratic Party health critic Adrian Dix said the government should do away with the current structure altogether.
"They should pay for the cost of Lucentis, pay for the cost of Avastin and let the doctors make the decision about what drugs are best for their patients," Dix said.
It's not the first time the government's plan has been criticized.
Dr. Jeff Blackmer of the Canadian Medical Association's office of ethics said in June, as the program was launched, "It provides a potential for a conflict of interest.
"The danger here is that the government set up the program in a way that automatically, physicians get a financial incentive to choose one medication over the other," Blackmer said.
He said he didn't think doctors' decision-making would be affected, but said the appearance of that potential was problematic and may lead patients to doubt their doctors' motives.
Government officials were unable to say on Tuesday how the new payment plan had affected usage of the two drugs in B.C. because they did not specifically monitor what the usage was before June 1.
Avastin is a drug approved for the treatment of colon cancer, though ophthalmologists regularly use it off-label to treat AMD.
Lucentis is specifically approved to treat the quickly advancing eye disease.
In a written statement Tuesday, the makers of Lucentis said they have seen a "significant drop" in the use of their drug in B.C., though the company provided no specific numbers to support the claim.
"The structure of the system provides a strong financial disincentive against using Lucentis," said the Novartis Pharmaceutical Canada statement.
"While we cannot discuss figures, we can confirm this is borne out by a significant drop in the use of Lucentis in B.C. since the system was implemented on June 1, 2009."
The makers of Avastin could not be reached for comment.
jfowlie@vancouversun.com
