News

In a surprise move, the Ontario government announced yesterday it will begin covering the cost of an expensive drug to treat macular degeneration, a leading cause of blindness, even though an alternative is widely available at a fraction of the cost.

It will cost the province's drug benefit plan roughly $100-million over the next three years to pay for Lucentis, a breakthrough drug that has been on the Canadian market since last September. The decision will give eligible Ontarians - primarily seniors - suffering from wet macular degeneration, a progressive eye disease that can rob them of their vision, access to this new drug for the first time, the province's Ministry of Health and Long-Term Care said in a statement.

But thousands of Canadians already have access to a similar drug that is much cheaper than Lucentis and that many ophthalmologists say is equally

effective.

The problem is that the alternative drug, called Avastin, was developed to fight colorectal cancer and isn't approved for use in the eye by Health

Canada.

Although many ophthalmologists in Canada regularly use Avastin to treat wet macular degeneration, the fact it doesn't have government approval gives significant leverage to Novartis Pharma-

ceuticals Canada Inc., which sells Lucentis in this country, to lobby governments to fund the high-priced drug.

"It's a very unusual situation," said Keith Gordon, head of research at the Canadian National Institute for the Blind.

The Common Drug Review, a federal body that recommends whether provinces should pay for certain drugs, has already rejected one request to recommend coverage for Lucentis. Novartis has asked the body to reconsider the issue, and a final decision is expected later this month.

Despite the existence of the CDR, provinces retain the freedom to decide whether certain drugs merit coverage. Ontario decided to give Lucentis a priority review and approved its application because of the compelling evidence of its benefits, said Helen Stevenson, assistant deputy minister and executive officer of Ontario public drug programs in the province's health ministry. Quebec is the only other province that has decided to cover Lucentis.

But some health-policy experts are criticizing Ontario for choosing to cover its cost despite the availability of Avastin. The decision will boost the drug company's profits at the expense of Canadians, who stand to benefit more from a cost-effective solution, said Arthur Schafer, director of the University of Manitoba's Centre for Professional and Applied Ethics.

"There's no reason to prefer [Lucentis] to Avastin, aside from the fact it has been tested and approved," he said. "Why would Canadian provinces be profligate in this matter, allowing the drug company really to suck out what will turn out to be tens or hundreds of millions of dollars from our health-care system?"

Instead of covering Lucentis, the government could fund research trials to examine Avastin, said Alan Cassels, a drug policy researcher at the University of Victoria.

But that message may be lost on governments that hear compelling evidence from advocacy groups and patients, who often receive money from pharmaceutical companies to speak about a drug, said Mr. Schafer.

For instance, Novartis provided money to the CNIB, in the form of an unrestricted educational grant, that is being used in part to fund its advocacy campaign supporting Lucentis. Novartis also has several paid ophthalmologists who promote the use of Lucentis.

But Dr. Gordon at the CNIB defended accepting the grants, saying the funding makes up less than 1 per cent of the association's budget.

"It really doesn't influence what we do or how we do it. Our reason for being involved in this is more than half our clients have [age-related macular degeneration]," he said.