Will the NHS pay?
This year is shaping up to be exciting as far as new and improved HIV therapies
are concerned.
So much so, some US doctors, not normally given to grandiose claims, have
made comparisons with the arrival of HAART in the mid-1990s.
Most of the fizz and fuss surround Merck’s raltegravir and Pfizer’s
maraviroc; two new drug classes that fight HIV replication in different ways
from currently available drugs.
Studies suggest they are safe and very effective. Though unavailable right
now outside clinical trials, they are likely to arrive within the next 18
months.
Neither pill is a magic bullet; both still have to be used with older drugs
(see current and past Treatment News pages). Nonetheless, they are important
new weapons for fighting HIV and drug resistance and represent a massive expansion
in treatment options.
Add to this Tibotec’s newly licensed PI darunavir/r and it’s all
round terrific news for people on failing regimes fast running out of HIV
drugs options. “These drugs will provide extended years of meaningful
survival to patients,” declared one doctor.
There’s good news also for people starting therapy; Gilead Sciences,
Bristol-Myers Squibb and Merck are soon to launch their three-in-one co-formulated
once-daily pill in Europe. Already available in the US, Atripla combines the
big guns efavirenz and tenofovir with nucleoside FTC.
But as with all new HIV drugs – when all these finally arrive they will
carry price tags that reflect their newness and pioneering nature.
In reality this means all people with HIV who want to switch to, or start
on, these new drugs may not get the chance sometime soon.
With this in mind, PN takes a closer look this month at who decides which
HIV drugs are available at your clinic and when they can be prescribed.
We found cost is increasingly influencing prescribing decisions in the UK.
Doctors are delaying starting people on therapies until the new financial
year to avoid further busting this year’s drug budget, while some persist
with starting people on cheaper HIV drugs that, while highly effective, are
associated with fat loss and anaemia. Meanwhile, London’s Mortimer Market
clinic is also taking a hard (cost-driven) look at CD4 and other tests to
see if some stable patients with HIV can get by with fewer.
It’s clear the pressure is on and is not going to go away. But people
unhappy with their regimens – who find them hard to tolerate or take
as prescribed – should not suffer in silence. You may not always get
exactly what you want but now more than ever people should be asking ‘what’s
the alternative?’ because very soon there will be many more effective
regimens to choose from.
Amanda Elliot, managing editor
