How NHS LPP is working with key partners to support patients with Wet Age-Related Macular Degeneration (AMD)

NHS London Procurement Partnership has been working with key partners across London on a High-Cost Drug Pan London Pathway and Health Economic Model tool which is aiming to provide enhanced care to patients with Wet Age-Related Macular Degeneration (wetAMD) – a condition which can cause loss of vision. We recently sat down with Denise Rosembert, Assistant Director for Medicines Optimisation (MOPP) to hear more about the project.

What is the wet AMD high-cost drug Pan London pathway in simple terms?

Wet Age-Related Macular Degeneration (wet AMD) is caused by proliferation of new blood vessels in the centre of the retina, leading to permanent vision loss. Treatment typically involves regular intravitreal injections of anti-VEGF into the eye, which are costly but effective. The pan-London Pathway aims to standardise treatment across London, ensuring equitable access to care while optimising costs. It serves as a guide for Integrated Care Boards (ICBs) to adapt based on local capacity and budget constraints, helping to address the lack of a unified approach, significant budget overspending and waiting lists in this area. Ophthalmology is one of the busiest specialties in the NHS, carrying out more than 500,000 operations every year (6% of the NHS total) and more than 7.5 million outpatient appointments.

Can you explain more about the dashboard work you are doing in Power BI?

Interactive tools:

1. Ophthalmology Anti-VEGF Intravitreal Injections Usage is an interactive report that consolidates clinical data and provides a visual analysis of anti-VEGF drug usage across London. It evaluates treatment patterns, drug costs, injection frequencies, and volume of usage per therapy, enabling better decision-making.
2. The health economic model is a tool for Ophthalmology High Cost Drug Pathways e.g. wetAMD treatments, allowing stakeholders to compare the cost impact of different drug pathways including biosimilars and newer, long-acting medicines. By presenting complex data (regarding appointment cost, cost of drug and appointment and drug cost combined), in an accessible format, the tool supports informed discussions about optimising treatment pathways and ensuring cost-effective care delivery.

How does this benefit patients? Is there a particular patient group this will help?

The pan-London Pathway will help to reduce unwarranted variation across the capital by enabling access to anti-VEGF medicines for patients, to maintain clinical choice and making better use of NHS resources. The pathway has taken clinical exceptions, capacity constraints and patient factors into consideration.

How does this benefit the wider NHS?

Standardising treatment pathways across London supporting better use of resources and addressing overspending. The pathway leverages biosimilars and other cost-effective drugs to lower expenses while maintaining high standards of care. It also recommends access to longer acting drugs when clinically appropriate and where capacity constraints in services are problematic for patient waiting lists.

The analysis highlights significant differences in drug costs and injection requirements. Currently, ranibizumab biosimilar is the lowest cost option when considering the drug cost in isolation, however, non-drug cost and impact on capacity is higher. When aflibercept biosimilar becomes available in late 2025, aflibercept may be the most cost-effective choice.

For patients needing more frequent injections, long-acting options like aflibercept 8mg or faricimab are recommended to reduce treatment burden. The pathway also considers the cost-effectiveness of step therapy and monotherapy over a five-year period, evaluating drug costs, clinic capacity, and patient outcomes.

How does this work relate to NHS procurement?

The pathway aligns with NHS England’s goals of adopting best-value biologic medicines, encouraging the use of biosimilars where beneficial to reduce costs. By supporting the introduction of ranibizumab biosimilars and preparing for aflibercept biosimilar uptake, the pathway promotes cost-efficient procurement.

Collaborative efforts with clinicians and ICBs ensure new products are incorporated into practice smoothly. The pathway also addresses marketing influences from pharmaceutical companies by prioritising clinical and economic evidence in decision-making.

A collaborative approach

We would like to acknowledge our colleagues in the pan-London Medical Retina Working Group, Trusts, ICBs and Pharmacy professionals that have supported this project. The pan London Pathway has been developed through extensive collaboration, including input from ophthalmology consultants, pharmacists, and NHS experts. By focusing on evidence-based solutions and shared learning, the project has established strong relationships, such as the pan London Medical Retina Working Group, to guide its implementation.

This effort not only benefits London but also informs national strategies, as systems incorporate these learnings into a broader framework. The goal is to ensure that the NHS is prepared for future innovations, such as aflibercept biosimilar and long-acting treatments, while achieving cost savings and maintaining high-quality care.

Helpful resources

Please contact us if you would like further information about the resources for ophthalmology:

• Therapeutics in retina webinar

• The dashboard for anti-VEGF London Procurement Partnership

• The Health Economic Modelling Tool for Ophthalmology High Cost Drugs

• The pan London wet AMD High cost drugs Pathway

Project team

• Denise Rosembert, Assistant Director for Medicines Optimisation, NHS LPP and Consultant Credentialed Pharmacist in Biologics and Advanced Therapies

• Dr Luke Nicholson, Director for the Medical Retina Service and Ophthalmology Consultant at Moorfields Eye Hospital

• Dr Shahid Malik, Strategic Health Economist, NHS LPP

Contact

Denise Rosembert - denise.rosembert@gstt.nhs.uk