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Clinical commissioning policy proposition on Pre-Exposure Prophylaxis
NHS England has today (10th August) launched a 45 day public consultation on a proposed clinical commissioning policy proposition on Pre-Exposure Prophylaxis (PrEP) for HIV.
There has already been extensive engagement on this policy and it has been developed with the support and input of lead clinicians and patient and public representatives. This approach has helped ensure that the views of key stakeholders have informed and influenced the development of the policy to date. We now wish to test the policy proposal further with wider groups of stakeholders.
Please note that this consultation is being run without prejudice to the outcome of an appeal following a judicial review.
View more information on the background to the judicial review and NHS England’s position on PrEP.
The HIV Pharmacy association are pleased that the review means that PrEP can be considered alongside other NHS services for funding. We question why there is a need to conduct further reviews and duplicate the comprehensive and robust reviews including detailed cost effectiveness and cost benefit analysis that has already been done by the NHSE PrEP policy task and finish working group. This was comprised of specialist doctors, pharmacists, commissioners from NHSE and local authorities, patient representatives and PHE. We hope NHSE recognise it would be the sole beneficiary of the cost avoidance (from treatment and care costs of those who without PrEP would be positive)from such a highly cost effective intervention. The NHS as an entity should be working with patients,other organisations & pharma companies to fulfil its commitment to an equitable and nondiscriminatory service for all patients and thereby consider equitable access for PrEP for all high risk groups as for other conditions
Consultation on the draft policy proposition, without prejudice to the appeal is now open until 23 September. If you would like your views to be considered as part of this process, please submit them through the online survey.
In relation to comments about the language used in the news article, the article accurately describes the group most likely to benefit from PrEP. This is based on the PROUD and IPERGAY clinical trials, which were conducted exclusively amongst men who have sex with men and who had multiple partners – the IPERGAY cohort reported a median of eight over two months, and PROUD participants reported ten over three months. It is also accurate that those who are at highest risk of contracting HIV are individuals who are less likely to wear condoms.
NHS England doesn’t have infinite resources for new specialised services, so we have to asses and compare each potential new intervention on their clinical benefits and costs relative to each other. This is not done to pit different groups of patients against each other, but to discharge the duty we have to achieve the greatest possible benefit for patients within the fixed resources provided by Parliament.
PREP must be made available to high risk groups, I find it appalling that it still isn’t! and believe that it stems from ignorance about MSM sex lives. It may also be worthwhile to advise a review of clinical decision making, including clinical decision making following a confirmed risk event between a person who has an STI confirmed and the partner or partners who follow advice to seek an intervention. This is particularly frustrating regarding a number of infections and results in patients who have had a sexual contact with a confirmed case not being treated for weeks or months because the clinician either has not properly assessed the risk that the patient will go on and have new sexual encounters while they wait for the result/s or they simply don’t understand that the patient could have been treated, with their approval, without a confirmatory test result . As a reminder, a number of STI’s aid HIV transmission between discordant couples and therefore it holds relevance to HIV.
Don’t waste NHS funding on those who choose to play Russian roulette with a deviant sexual lifestyle. Save the NHS for those who cannot help being sick. They already have free condoms which should be used. Don’t play with fire and you wont get burned. No one is forced to have sex with dangerous contaminated partners.
Well done NHS for trying to save public funds for those who really need it. The NHS should not be made to fund deviant lifestyles and those who choose to play Russian roulette. No one is forced to have sex with dangerously contaminated people who seem hell bent on putting a pox on the world. A condom is is already given freely I would suggest it is used. Save The NHS for those who cant help being ill.
It is quite plain to me that NHSE’s reluctance to commission PrEP is short-sighted.
Firstly, it is not technically a prevention measure, as argued. It is a treatment in the event of infection. It doesn’t stop the infection happening, it stops it taking hold.
The NHS quite happily prescribes the same drug as PEP – which functions in exactly the same way. Why is there a difference in the attitude to commissioning.
Secondly, with its effectiveness proven by the PROUD study, it would clearly be cost effective. Patients would not take PrEP as a lifelong treatment rather for periods of their life when they are particularly at risk. The cost saving of that versus lifelong HAART treatment is obvious.
The argument that it will increase promiscuity and potentially STIs has not been borne out by he clinical studies. In any case, if a vaccine or cure were found, would the NHS not prescribe them for the same unfounded fear? Of course not. Please do the right thing and help end the scourge of HIV.
I don’t think information about this proposal have clearly articulated that future costs of this drug are likely to fall. Perhaps significantly. I think that’s an important point.
What does this mean for PROUD participants coming to the end of the 2 year trial and support and medication.
Ethically the sudden cut off from services, support and life changing medication is questionable and causes who concerns and will undoubtedly see the rise of many more new HIV infections.
I would support the prescribing of HIV prophylactic medication if only to reduce the prescribing costs of full blown HIV further down the line. There could be savings if this route is taken. There are other NHS costs which could be further reduced to help cover the initial outlay. Eg. Strict limits on fertility drugs. Children are a gift and not a right however sad that may seem to those whose fertility is low.
PrEP should NOT be available on the NHS. Condoms offer a far safer alternative.
This cannot be compared to the contraceptive pill, if on a cost basis only. Had the contraceptive pill cost £400 a month it would not be available either.
Gay men make the choice to engage in a very dangerous form of sexual activity, i.e. anal sex (especially with multiple partners). They are at risk of contracting a number of other STDs not protected against by PrEP.
Only condoms (or abstinence) offer protection. These are, of course, readily available at low cost.
Are you really that nieve? It isn’t just aimed at gay men, it would be available to everyone regardless of sexuality. A woman has the right to the pill to prevent pregnancy, so why can’t everyone else have the freedom to fulfill there sexual needs with the added protection of prep as well as using a condom. Please remember condoms split!