I'm a doctor with a miracle drug. Three of them, in fact. Their names are Avastin, Lucentis and Eylea. I use them to treat the number one cause of blindness in Americans over sixty-five: wet age-related macular degeneration (AMD). Calling them a miracle is no understatement. If your doctor delivers the unlucky news that you've developed wet AMD, it means blood vessels under your macula have started to leak or bleed, robbing you of the sight you rely on to read books, see faces, watch TV or drive.
Enter the miracle drugs—eye injections that limit those leaking submacular vessels, giving us our first treatment capable of bringing vision back. But somehow, these drugs have become among the most controversial in all of medicine.
All three treat wet AMD very effectively. Their most significant difference is cost. Lucentis and Eylea cost approximately $2,000 and $1,850 per dose, respectively. Avastin? Only $50.
Medicare covers them all, so retina doctors and their patients are free to choose whichever medication they wish. A recent survey of our field showed that 64.3 percent of us choose Avastin as our first-line drug. Yet about 35 percent of retina specialists continue to use the expensive medicines as their first treatment of choice. Why?
Most likely, because they feel these drugs are better than Avastin. After all, we're taught to adhere to the ethical duty to "treat patients the way we'd treat our mothers, or ourselves," right? That's a mental check of ethics I employ during virtually every patient visit, every single day.
But what if, in addition to an ethical duty to do what we feel is best, we also had an ethical duty to recommend the most cost-effective care?
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