The cost of drugs for age-related macular degeneration in Canada and internationally

PDF - 821 kb

1. Anti-VEGFs used to treat retinal conditions have seen rapid sales growth over the past decade

In 2007, Lucentis became the first anti-VEGF launched in Canada approved for wet AMD as well as other important retinal diseases. It was quickly recognized as the new gold standard for treatment. In 2013, Eylea was also approved for AMD and launched at a slightly lower price; other indications were later added.

Combined sales for these two drugs reached $692M in 2017. Until 2013, in the absence of a competitor, Lucentis had dominated the market and enjoyed solid growth; however, by 2017 Eylea had surpassed it in annual sales. In 2017, Eylea captured 56% of the combined sales, reflecting a slightly greater share of actual units sold (59%) due to its lower cost.

2. Lucentis and Eylea account for a higher pharmaceutical market share in Canada than in most other OECD countries

Lucentis and Eylea accounted for 2.8% of total pharmaceutical sales in Canada in 2017, the seventh-highest share in the OECD. Of the PMPRB7 countries, Canada placed fourth behind the UK, Switzerland, and France. In general, a higher comparative market share may point towards a higher rate of consumption, higher prices, or a combination of both factors, although it is also affected by the relative sales in the rest of the pharmaceutical market.

Eylea had higher sales than Lucentis in 17 of the 29 OECD countries with available data, similar to the distribution in Canada. In the top 10 countries with the highest combined market share, Eylea captured at least 40% of sales. Notably, Eylea had less than 0.1% of the total pharmaceutical market share in the US, the lowest of all PMPRB7 countries.

3. Consumption of Lucentis and Eylea in Canada is among the highest in the OECD

Canada has the third highest per capita consumption of Lucentis and Eylea in the OECD. The findings are presented as an index, where the consumption rate in Canada is set to 1 and the rates in other countries are reported relative to this value.

In the PMPRB7, only Switzerland has a higher rate of consumption. Like Switzerland, Australia, the UK and France, Canada has both a high consumption rate and a high combined share of total pharmaceutical sales, indicating that the Canadian experience with Lucentis and Eylea is similar to that in other developed countries. Low consumption in the US and other markets may be due, in part, to the off-label use of Avastin for retinal conditions, which due to data limitations is not considered in this analysis.

4. Canadian prices for Lucentis and Eylea are at the higher end of the OECD spectrum

In the last quarter of 2017, Canadian prices for Lucentis and Eylea were second only to the US among the PMPRB7 comparator countries, and significantly higher than the OECD median. The median PMPRB7 price for Lucentis, set by Italy, was 37% less than the Canadian price; while the PMPRB7 median for Eylea was the 15% less, set by the UK. These results indicate the potential for significant cost implications if Canadian prices were closer to median international levels.

5. Higher prices for Lucentis and Eylea translated into approximately $168 million for Canadian payers in 2017

The price differentials between Canadian and foreign markets translate into substantial cost implications for Canada. If Canadian prices for anti-VEGFs were aligned with the PMPRB7 median price levels for the fourth quarter (Q4) of 2017, the national Canadian sales for Lucentis would have been up to $110.4M (36.5%) lower in 2017, while sales for Eylea would have been $57.9M (14.9%) less. Similarly, the cost implications for public plans would have been $79.7M for Lucentis and $26.5M for Eylea for the 2016/17 fiscal year.

NPDUIS is a research initiative that operates independently of the regulatory activities of the PMPRB.