[Age-related macular degeneration--a public health problem]

Verteporfin for the treatment of age related macular degeneration was identified as a potential breakthrough technology by the Working Group on Medical Procedures of the German Standing Committee of Physicians and Sickness Funds in spring 2000. Consequently, a formal review was undertaken to assess the benefits and risks of this treatment in order to evaluate its future status in German statutory ambulatory health care. The treatment effect of verteporfin was established in a high quality randomized controlled trial, for the predominantly wet, classic type of choroidal neovascularization secondary to age related macular degeneration. For this patient group, verteporfin is regarded as a reasonable and necessary procedure as there is no effective alternative therapy for this type of macular degeneration. However, the treatment stabilizes the patient's vision rather than improves it and the long term effects must still be evaluated in further clinical trials. After a thorough review of the scientific literature and the statements of various stakeholders the Standing Committee decided to introduce this technology into the statutory healthcare benefits package. For the most effective use of this treatment it must be assured that, prior to treatment, the AMD type (wet vs. dry, classic vs. occult) is correctly diagnosed (using fluorescein angiography) and documented by specially trained physicians. For this reason a stringent quality assurance guideline was developed to prevent the use of this costly technology for non-approved indications. Further indications for this therapy are currently under evaluation in randomized controlled trials. Hence, this decision will need to be updated in future.