At least DKK 100 mill. That is the sort of money Danish regions can expect to save every year, with no detriment in the treatment offered to patients.
Three new treatment guidelines from the Danish Medicines Council and a subsequent tendering procedure conducted by the regions medicines organisation, Amgros, will make medicines to treat a number of common eye diseases much cheaper from the turn of the year.
The medicines are to treat eye diseases such as age-related macular degeneration (AMD), diabetic macular oedema (DME) and retinal vein occlusion (RVO).
Thousands of Danes suffer from these eye conditions, which lead to impairment of vision and in some cases blindness. All three diseases can be treated with the same type of medicine, the so-called VEGF inhibitors.
The price reductions come after the Danish Medicines Council made two medicines equivalent for treating the three eye diseases in its treatment guidelines. One of these medicines is ranibizumab, with the trade name Lucentis, and the second is aflibercept, better known under the trade name Eylea. From October 2019 to September 2020, Eylea alone cost the regions DKK 355 million.
The Danish Medicines Council has assessed that both medicines are equally good to treat eye diseases in terms of both their effect and side-effects.
The three treatment guidelines were approved by the Danish Medicines Council in August 2020. After this, Amgros held a tendering procedure, in which the companies behind the two equal medicines were invited to submit a tender for their product for Danish patients. Exposure to market mechanisms has meant that the pharmaceutical companies have significantly reduced their prices.
The chair of the Danish Medicines Council, Jørgen Schøler Kristensen, is extremely pleased with the process.
"It will benefit patients in ophthalmology departments and the healthcare system in general. Eye patients have been shown what medicines work best for their disease, so that they can stop the deterioration in their vision better. At the same time, the DKK 100 million we release on eye medicines will benefit other places in the healthcare sector,” said Jørgen Schøler Kristensen. He shares the chairmanship with Steen Werner Hansen.
Amgros CEO, Flemming Sonne, is also satisfied that the equivalence of products by the Danish Medicines Council, and Amgros’ tendering procedure can challenge pricing by companies.
“We’ve stirred up competition between the pharmaceutical companies that we would otherwise not have had. Making the pharmaceuticals equivalent has helped lower prices. And that’s extremely good, because it releases resources that can benefit other patients,” said Flemming Sonne.
Wet AMD (age-related macular degeneration)
About 15,000 patients have wet AMD in Denmark.
Age-related macular degeneration (AMD) is a chronic eye disease in the central part of the retina (macula – also called “the yellow spot”), leading to damage and weakening of the retina.
AMD is characterised by increasing and permanent weakening of sharp vision. Globally, the disease is the reason for 8.7% of all cases of blindness. AMD strikes over 50 year-olds, and it is the most frequent cause of impaired vision and social blindness in Denmark. Social blindness means a reduction of vision large enough to cause problems with social interactions. Wet AMD arises because fluid accumulates in the retina.
RVO (retinal vein occlusion)
Approximately 2,700 patients in Denmark annually are diagnosed with a blood clot in the veins of the retina (retinal vein occlusion). Of these, only around 820 require treatment.
Retinal vein occlusion (RVO) is a blood clot in the vein system in the retina, and the resulting lack of oxygen leads to damage to retinal tissue and thus vision. The risk of developing RVO increases with hardening of the arteries, high blood pressure, high pressure in the eye, and congenital problems with the blood’s ability to clot.
The incidence of RVO increases with age, and is most frequent in people over 50. The symptoms of RVO are acute impairment of vision without pain. The impairment of vision is partly due to lack of oxygen in the areas of the retina affected by the blood clot, and partly because of increased fluid in the retina as a consequence of the increased pressure on the blood vessels in the retina behind the blood clot.
DME (diabetic macular oedema)
Diabetes is a frequent metabolic disorder, and it has been estimated that 250-270,000 people are affected by the disease in Denmark. Diabetes can lead to a number of complications, including in the eye. The most serious of these complications is damage to the blood vessels in the retina (diabetic retinopathy), which is a common cause of impaired vision and blindness in the Western world.
The disease has two sight-threatening forms. In the one form, the retina forms new and fragile blood vessels (proliferative diabetic retinopathy). In the second form (diabetic maculopathy) fluid seeps out around the macula, the retina’s yellow spot, which is called diabetic makular oedema (DME). Among other things, the oedema is due to leaks in walls of the vessels because of high levels of vascular endothelial growth factor (VEGF). Diabetic macula oedema often leads to loss of vision if it is not treated, and the severity depends on whether the central vision is affected.
It has been estimated that in Denmark approx. 450 patients a year get DME affecting the central vision, i.e. require treatment and could benefit from treatment with VEGF inhibitors.
Amgros’ tendering procedures
Tendering procedures at Amgros are regulated by the EU Public Procurement Directive Public Procurement Directive, and the Danish Public Procurement Act (udbudslov). The EU's threshold value for goods is currently DKK 1.5 million. In order to ensure competitive prices, Amgros follows a principle to send all procurement exceeding a total amount of DKK 500,000 out to an EU tendering procedure.
Amgros endeavours to establish agreements lasting for at least one year. Half of the agreements take effect from 1 April and run until 31 March in the following year. The other half follow processes at the Danish Medicines Council.
Over the last 12 months, Amgros has published 133 EU tendering groups and had a turnover of DKK 9.1 bn. with savings of 39.75%.
Senior communication specialist
I’m responsible for overall communication at Amgros, including PR. And I help to ensure that we communicate with the surrounding world in an open and engaging manner.