I don't follow Lucentis / Avastin so my comments may be off base....but I'm not so sure that evidence marginally favoring Lucentis would be good for it's marketing. For just about any other drug you could use this to gain market share. But if your competitor (Avastin) was held back by a lack of evidence and now that evidence exists...it might get the bigger boost as a result. Outside of the US there is perhaps more cost concern (at least from the point of view of the payer, if not so much from physicians). If you can treat 40 times as many people with Avastin for the same money, and if the choice to use Lucentis might mean introducing eligibility criteria which wouldn't see everyone treated...what would you, as the payer, do? These are not my decisions to make, though I do have some experience sitting on advisory groups providing medical opinion relevant to such decisions. I would personally rather treat a lot of people with a slightly inferior drug than to let a substantial number of people go untreated.
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