Lucentis (ranibizumab, Genentech/Roche) and Avastin (bevacizumab, Genentech/Roche) are the leading treatments for Wet Age-Related Macular Degeneration (AMD), Diabetic Retinopathy (DR), and Retinal Vein Occlusion (RVO).  Interestingly, the drugs are similar and were developed by the same company, yet have very different costs.  Currently, a dose of Lucentis costs approximately $1,950 while a dose of Avastin costs approximately $50.

Why, if they are so similar and made by the same company are the costs so different?  The answer is actually quite complicated.  In reality, a dose of Avastin for its true indication (cancer) is about $3,000.  What happens is that when it is used for treatment of retinal conditions, a compounding pharmacy prepares and aliquots the doses for eye injections (50-60 doses in one vial of Avastin).  That is why the cost for a dose for eye treatments goes down.  Therefore, Avastin is an anomaly that is quite unique in medicine.

This brings up the question: Why are drugs so expensive anyway?  The answer here is that the government, in other words, the Food and Drug Administration (FDA) requires a complex and expensive process for drug approval.  It is estimated that the cost of developing a drug and making it through the FDA process costs between $800 million and $1 billion.  If one then factors in that less than 10% of drugs developed are approved by the FDA, then one sees that developing a drug and getting FDA approval is a high stakes, risky proposition.  So, when a drug company prices a drug, it factors in the costs of development, FDA approval, and potential earnings of that drug, but also of other drugs that did not make it through the process.  If drug companies could not make a return on their investment, drug development would end and we would see the end of new therapies for the many unmet medical needs.

BOTTOM LINE:  We prefer to use an FDA-approved drug when it is available and covered by your insurance because: 1) it shown to be safe for use in the eye, 2) it is the “right” thing to do to allow the drug development process for future therapies.  The cost issue stems directly from the government’s process of drug approval, and should not factor into a physician’s decision in providing the best care for a patient.  The issue of cost should be addressed by the government and the pharmaceutical industries to allow for cost-effective medical care in the future.