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Written Statement - Treatment of Wet Age Related Macular Degeneration

Mark Drakeford, Minister for Health and Social Services

On 13 September a meeting of the Welsh Retinal Group took place.  This Group was established to engage with the Welsh Government on the provision of patient services for the treatment of Wet Age Related Macular Degeneration (“Wet AMD”).

I set out below, in more detail, the history and background to the treatment of Wet-AMD and inform Members of my decision to extend the treatment of Wet AMD to include use of the drug Aflibercept in addition to the drug Lucentis.  This service will be delivered from the autumn of 2013.

Background

Since November 2008 the Welsh Government has funded Local Health Boards to provide the drug Lucentis for the treatment of Wet AMD in line with guidance produced by the National Institute for Health Care Excellence (“NICE”).

The NICE guidance, issued in July 2013, recommended the use of Aflibercept for Wet AMD treatment and as such I agreed that my Officials should engage with the ophthalmologists in Wales currently undertaking treatment of Wet AMD using the drug Lucentis. I asked them to consider the implications of the NICE recommendations and associated costs on an all-Wales basis.  

The purpose of this engagement was:

  • to discuss the development of a programme for delivery;
  • to discuss the most effective use of manpower and which health professionals should be involved in the service;
  • to address any outstanding issues with regard to primary care referral into the service and to reaffirm the agreed referral protocols with optometry; and
  • to review new treatments so that they can be introduced into the service as appropriate.

Discussions have resulted in agreement in principle from the service to deliver:

  • Treatment of Wet AMD for both first and second eyes using the drug Aflibercept and Lucentis;
  • Review of all drugs for the treatment of Wet AMD currently undergoing clinical trials so that they may be provided for treatment as soon as they are licensed;
  • Gradual phasing in of treatment using the drug Aflibercept, achieving a rate of at least 20% of patients receiving anti-VEGF treatment for Wet AMD receiving Aflibercept within 12 months;
  • Appraisal of the treatment protocols by the Welsh Retina Group and ratified via the Ophthalmologist Specialist Advisory Group (“OSAG”) after six months and reappraisal after twelve months to ensure the service delivers the best outcomes for patients; and
  • Appropriate referral of service issues from OSAG to the Chief Optometric Advisor, to ensure that patients are assessed and treated to receive the maximum visual benefit. In addition we will ask Health Boards to review the current electronic record systems to ensure accurate data and funding forecasts.

Future Funding

It should be noted that this statement sets out the current commitment to funding Aflibercept and Lucentis treatment for Wet AMD. 

Whilst Aflibercept and Lucentis are currently accepted as the most effective drugs available in preventing further sight loss, it is not successful in all cases.  Parallel to my current action, I will seek advice on best practice as the results of further clinical trials become available.  Avastin is currently being medically trialled with encouraging early results.  If this drug receives approval, then the drug cost of Wet AMD treatment would reduce dramatically.  


Service Audit

I have asked Officials to continue to audit LHBs performance in this area very tightly over the coming months as the new service develops.  It is important to manage the provision of this treatment carefully, to avoid any undue concerns being raised by patients.

To ensure that there is consistency in the application of my directive by the NHS in Wales, I have asked my Chief Optometric Advisor to schedule meetings with the Chair of the Welsh Retina Group via OSAG to audit the LHB’s application of my policy at regular intervals. The audit will be based on previously used criteria and will include an assessment of the success and suitability of the treatment.

I have also asked the All Wales Medicine Strategy Group to review all drugs for the treatment of Wet AMD currently undergoing clinical trials.