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Anger after NHS warns PrEP HIV drug could put other treatments at risk Anger after NHS warns PrEP HIV drug could put other treatments at risk
(35 minutes later)
A warning from NHS England that it cannot confirm funding for drugs to treat rare conditions including cystic fibrosis in children if it is to pay for an HIV prevention pill has been criticised as “invidious” by Aids campaigners who say it calls into question the organisation’s impartiality. A warning from NHS England that it cannot confirm funding for drugs to treat rare conditions including cystic fibrosis in children if it is to pay for an HIV prevention pill has been criticised as “invidious” by Aids campaigners, who say it calls into question the organisation’s impartiality.
The high court ruled on Wednesday that NHS England can fund pre-exposure prophylaxis (PrEP), a medication that cuts the risk of HIV infection by almost 90% and is aimed particularly at men who have unprotected sex with multiple male partners.The high court ruled on Wednesday that NHS England can fund pre-exposure prophylaxis (PrEP), a medication that cuts the risk of HIV infection by almost 90% and is aimed particularly at men who have unprotected sex with multiple male partners.
NHS chiefs immediately said they would appeal against the decision and warned that if the health service is to be responsible for providing the HIV therapy, at a cost of £10m-£20m a year, it may not fund other treatments.NHS chiefs immediately said they would appeal against the decision and warned that if the health service is to be responsible for providing the HIV therapy, at a cost of £10m-£20m a year, it may not fund other treatments.
As well as a cystic fibrosis drug for children, eight other treatments would be under threat of having funding cut, according to the NHS, including stem cell transplants for a rare blood cancer and prosthetic knees for amputees.As well as a cystic fibrosis drug for children, eight other treatments would be under threat of having funding cut, according to the NHS, including stem cell transplants for a rare blood cancer and prosthetic knees for amputees.
In a statement, the National Aids Trust (NAT) said no assessment had yet been made about the cost effectiveness of PrEP. “Every policy funded involves money being spent on that policy and not on a policy which in the end is not funded. To single just PrEP out as a policy which would be funded at the expense of others is invidious, prejudices NHS England’s position in relation to PrEP and raises serious questions as to the integrity and impartiality of NHS England’s approach,” the statement said. In a statement, the National Aids Trust (NAT) said no assessment had yet been made about the cost effectiveness of PrEP. “Every policy funded involves money being spent on that policy and not on a policy which in the end is not funded. To single just PrEP out as a policy which would be funded at the expense of others is invidious, prejudices NHS England’s position in relation to PrEP and raises serious questions as to the integrity and impartiality of NHS England’s approach,” it said.
Related: Users of HIV prevention PrEP urge NHS to fund 'life-changing' medicineRelated: Users of HIV prevention PrEP urge NHS to fund 'life-changing' medicine
Drugs for rare conditions are categorised by price and effectiveness, from level one to five. The NHS statement said: “Given the ruling, NHS England cannot confirm funding for those treatments and services in levels three and four.” It did not name specific conditions.Drugs for rare conditions are categorised by price and effectiveness, from level one to five. The NHS statement said: “Given the ruling, NHS England cannot confirm funding for those treatments and services in levels three and four.” It did not name specific conditions.
Deborah Gold, the chief executive of the NAT, told the Times the statement was “deeply unhelpful”.Deborah Gold, the chief executive of the NAT, told the Times the statement was “deeply unhelpful”.
She said: “NHS England press releases now appear to be pitting PrEP against other treatments. Had NHS England not unlawfully pulled PrEP from its decision-making process in March, all prioritised new policies and drugs would now already be funded.”She said: “NHS England press releases now appear to be pitting PrEP against other treatments. Had NHS England not unlawfully pulled PrEP from its decision-making process in March, all prioritised new policies and drugs would now already be funded.”
Other treatments at risk of losing funding include a drug to prevent low sodium levels in the blood of chemotherapy patients, a childhood narcolepsy treatment and brain implants for children with hearing problems.Other treatments at risk of losing funding include a drug to prevent low sodium levels in the blood of chemotherapy patients, a childhood narcolepsy treatment and brain implants for children with hearing problems.
The NAT brought the high court case following anger and consternation among campaigners after NHS England said it would not fund PrEP because it did not have the power to do so. It argued that it was the role of local authorities, which have been given control of public health measures including reducing smoking and family planning as well as HIV prevention. Local authorities said they did not have the money to pay.The NAT brought the high court case following anger and consternation among campaigners after NHS England said it would not fund PrEP because it did not have the power to do so. It argued that it was the role of local authorities, which have been given control of public health measures including reducing smoking and family planning as well as HIV prevention. Local authorities said they did not have the money to pay.
Mr Justice Green in the high court said NHS England had erred and that both it and the local authorities were able to fund the drugs if they so chose.Mr Justice Green in the high court said NHS England had erred and that both it and the local authorities were able to fund the drugs if they so chose.
“No one doubts that preventative medicine makes powerful sense,” he said in his judgment. “But one governmental body says it has no power to provide the service and the local authorities say that they have no money.“No one doubts that preventative medicine makes powerful sense,” he said in his judgment. “But one governmental body says it has no power to provide the service and the local authorities say that they have no money.
“The claimant [the National Aids Trust] is caught between the two and the potential victims of this disagreement are those who will contract HIV/Aids but who would not were the preventative policy to be fully implemented.”“The claimant [the National Aids Trust] is caught between the two and the potential victims of this disagreement are those who will contract HIV/Aids but who would not were the preventative policy to be fully implemented.”
Gold said it was “enormously disappointing” that NHS England had decided to appeal against the ruling. “We call on NHS England to abandon its appeal, to allow the commissioning process to take its course and to stop pre-empting publicly the discussions and decisions which should properly take place in the Clinical Priorities Advisory Group.” Gold said it was “enormously disappointing” that NHS England had decided to appeal against the ruling. “We call on NHS England to abandon its appeal, to allow the commissioning process to take its course and to stop pre-empting publicly the discussions and decisions which should properly take place in the clinical priorities advisory group.”