Health economics is a black art practised by big business, lawyers and politicians. It dictates terms to the health professions and controls the care they provide to patients but is seldom in their favour.

Until now. Last week’s court victory for clinical commissioning groups wanting to use Avastin over Lucentis and Eyelea for macular degeneration was a rare moment of common sense in a battle that has raged for 15 years. The drugs share the same basic chemistry but the cancer drug, Avastin, is provided in large amounts at low cost. Its ophthalmological counterparts are tiny amounts that cost a lot. It’s over 14 years since Optician first reported on ophthalmologists using Avastin off licence so it’s a fair bet the cheaper drug’s AMD benefit has been known about for very much longer.

Seeing the clear financial opportunities, the drug companies declined to have Avastin licensed for ocular use. True to form the authorities, politicians, regulators and controlling bodies ignored the medical profession and refused off licence use. In the UK’s NHS surgeons were faced with breaking NICE’s rules to offer the lower cost Avastin.

Over the past 15 years I have only met one person who didn’t see the clear case for using Avastin to treat AMD. In a terse exchange, at a party, a drug company executive told me in no uncertain terms how expensive creating vials of Lucentis was and if people weren’t going to pay properly for drugs the big pharma companies wouldn’t bother developing them. Nice.

As ever the true winners will be the lawyers. With the ink still drying on the CCGs’ victory notice of an appeal has been issued and more public money will be poured down the drain fighting big pharma’s legal challenge.