NICE is unable to make a recommendation about the use in the NHS of ranibizumab for treating diabetic retinopathy because Novartis did not provide an evidence submission. The company has confirmed that it does not intend to make a submission for the appraisal because it will not add value. Most people with proliferative diabetic retinopathy will also have diabetic macular oedema, and these people can already have ranibizumab in England and Wales (NICE technology appraisal guidance 274). For people with proliferative diabetic retinopathy with no macular involvement, panretinal photocoagulation is the preferred treatment. There is unlikely to be sufficient evidence that ranibizumab is a cost-effective use of NHS resources compared with panretinal photocoagulation.
If NHS organisations wish to consider ranibizumab for treating diabetic retinopathy they should follow the advice on rational local decision making in the NHS Constitution for England and the NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. This outlines the approach that should be taken when there is no NICE guidance.
NICE will review the position if the company decides that it wants to make an evidence submission.