Things must be changing in the NHS when the health service decides to pay for straight comparisons of drugs - it's always the pharmaceutical company which hopes to sell its product, the one that pays for drugs trials against a rival medicine.

But this time it has been the NHS that has funded research in which the anti-blindness treatment Avastin has gone head to head with Lucentis. If you wonder why they have troubled with such a study, the answer is that £84.5 million can be saved by using the cheaper one.

The cheaper one is Avastin, at £40 a vial. However, the only licensed one is Lucentis, at the astonishing price of £741 per shot.

Avastin is intended to treat bowel cancer, but a study by the National Institute for Health Research has shown that it also works just as effectively and safely as Lucentis in treating "wet" age-related macular degeneration.

The first year's results of the trial, called Ivan,compared the drugs in 610 patients, making it one of the largest carried out in eye disease in the UK.

"The Ivan results at the end of the first year show that Lucentis and Avastin have similar effectiveness. Regardless of the drug received, or treating monthly or as needed, sight in the affected eye improved by between one and two lines on a standard eye test," said Prof Usha Chakravarthy of Queen's University Belfast's centre for vision and vascular science, who led the study team.

Lucentis, the current official choice, is made by Novartis, which has claimed the better performance of their drug over Avastin.

Doctors can use unlicensed drugs as long as they are held responsible if something goes wrong. The next logical step then would be having more UK ophthalmologists ready to use Avastin.

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