The Price of Sight — Ranibizumab, Bevacizumab, and the Treatment of Macular Degeneration

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Abstract
On June 30, 2006, the Food and Drug Administration (FDA) approved ranibizumab — which is manufactured by Genentech and marketed as Lucentis — for the treatment of neovascular age-related macular degeneration. Ranibizumab is a fragment of a recombinant monoclonal antibody (see Figure 1 ) that binds to and inhibits all the biologically active forms of vascular endothelial growth factor A. Administered by injection into the vitreous cavity (see Figure 2 ), ranibizumab prevents vision loss and improves visual acuity, with few serious adverse effects (as indicated in the reports by Rosenfeld et al. and Brown et al. in this issue of the Journal, pages 1419–1431 and 1432–1444); it thus represents a substantial advance against a leading cause of blindness (discussed by de Jong in this issue of the Journal, pages 1474–1485). According to the prescribing information, it is recommended that ranibizumab be injected monthly, with treatment likely to be required indefinitely, although less frequent administration is being evaluated. Ranibizumab is also expensive. The wholesale acquisition cost of a vial containing a single dose of 0.5 mg (0.05 ml) is $1,950.

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