Brolucizumab for treating diabetic macular oedema

1.1 Brolucizumab is recommended as an option for treating visual impairment due to diabetic macular oedema in adults, only if:

1.2 If patients and their clinicians consider brolucizumab to be 1 of a range of suitable first-line treatments (including aflibercept and ranibizumab), choose the least expensive treatment. Take account of administration costs, dosage, price per dose and commercial arrangements.

1.3 These recommendations are not intended to affect treatment with brolucizumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Diabetic macular oedema is usually treated first with aflibercept or ranibizumab, which are already recommended by NICE for treating diabetic macular oedema if the eye has a central retinal thickness of 400 micrometres or more when treatment starts. Brolucizumab is another treatment option that works in a similar way.

Evidence from clinical trials shows that brolucizumab is as effective as aflibercept. An indirect comparison of brolucizumab with ranibizumab also suggests similar clinical effectiveness, although this is uncertain.

A cost comparison suggests brolucizumab has similar costs and overall health benefits to aflibercept or ranibizumab. So, brolucizumab is recommended for treating diabetic macular oedema if it is used in the same population as aflibercept and ranibizumab.