Letter from Wanda Hamilton,
AMD Alliance International

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Mr. Andrew Dillon
CEO, NICE
By email, July 4, 2007

Dear Mr. Dillon,

At the request of the Board of AMD Alliance International, I am writing to express our strongest concern about your preliminary guidance on anti-VEGF treatments. We are dismayed with the substance of your guidance, and believe that it does not do justice to the evidence presented to NICE.

We are concerned that you have not adequately assessed the quality of life outcomes for those who may be successfully treated with anti-VEFG drugs. We note that patient experts have participated formally in the consultations, but we do not within your appraisal consultation document see any hallmarks of this consultation. In your final review, we would urge you to make it more transparently obvious that you have carefully considered the patient experience and document how this has impacted your decision.

Our second concern relates to your recommendations on limitation of use by sub-type. We fail to understand why you have made this distinction given that clinical trial results published in the New England Journal of Medicine (October 2006), offer evidence that ranibizumab is effective for all types of AMD. It is unacceptable to deny, on any basis, hope and help to any person with AMD who might benefit from proven treatments.

This leads us to our third concern. Your cost effectiveness calculations fail to take correct account of the manner of administration of anti-VEGF treatments (outpatient treatment against day-care). Furthermore, you have vastly underestimated the true costs of AMD to the NHS and Social Services in your cost model. You have demonstrably over-estimated the cost of treatment and under-estimated its benefit to patients and the cost of blindness to society.

The only acceptable outcome for persons with AMD is a thorough review of all evidence. This should include up-dated data for use in the cost calculations and a full appraisal of the patient testimonials. We believe that such a review can only result in a decision to recommend, without limitation to sub-types, both pegaptanib and ranibizumab for use on the NHS.

Sincerely,

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