Examination of Witnesses (Questions 400-403)
DR BARRY
EVANS, MR
NICK PARTRIDGE,
MR JOSEPH
O'REILLY, DR
PETER WEATHERBURN,
DR ALEC
MINERS AND
MR JOHN
IMRIE
TUESDAY 23 JULY 2002
Julia Drown
400. In the strategy it says the lifetime costs
for an HIV-positive individual could be up to £180,000 and,
prevention, if you are looking at also benefits as well as savings
in health service costs it could be anything between half a million
and a million pounds. Does your work suggest those figures are
in the right sort of region? Would you have any other comments
to make on those costs?
(Dr Miners) Absolutely. Particularly with relevance
to cost, I would point to the paper to which I referred a moment
ago. If you look at the costs and the costs of treating people
with HAART they were in the £180,000 region. I am not sure
where that particular £180,000 came from to which you were
referring. The benefits of treatment depend a bit on what you
mean by benefits and how they are calculated. One of the problems
we had when actually trying to do these studies originally was
that we had some figures on mortality, but in terms of morbidity
there are very few studies there that we could try and synthesise
into the models. In terms of the health benefits, if you want
to talk about quality of life, I would say that we have under-estimated
costs on those studies.
(Mr Partridge) It seems to me from my activist past,
if you like, that we have in one sense scored an own goal in talking
about the high cost of therapy because when you listen to what
Dr Miners says, it is clear that in terms of benefit gained these
are very reasonable costs attached and we are seeing a reduction
in per year drug costs over time. The other point I wanted to
raise was the half a million pound to one million pounds per infection
stopped cost, because that obviously folds in with the other impact
of economic benefits lost to the country, the loss of useful time,
and so on. I just want to set that half million to one million
pounds into context. If you look at the current Department of
Health funding for the CHAPS programme, which is the Community
HIV and AIDS Prevention Strategy, which is a partnership which
Terrence Higgins Trust runs, that is currently running at about
£1.1 million a year, so it is arguable that the only outcome
from that is two stopped infections in year. You can also look
at it another way that says we as a country get extraordinarily
good value through that programme. You can look at it a third
way which says there needs to be increased investment for targeted
prevention works that can be shown to work. Fortunately, the independent
researcher that we at the Terrence Higgins Trust commissioned
to do all of the background research is Sigma here so we do have
good, robust evidence that the CHAPS programme is working and
that it is extraordinarily cost-effective.
Chairman
401. Could I ask Dr Miners, from your perspective
what do you think is the most cost-ffective way of addressing
the kind of issues we talked about today? You answer a specific
question, can I broaden out the point, from the committee's point
of view we need to look at what we recommend, perhaps you are
in a more objective position to have an overview of the expenditure
in these areas, what do you suggest are the target areas we should
look at?
(Dr Miners) Do you mean in terms of prevention versus
treatment?
402. Absolutely, yes.
(Dr Miners) I think the problem with making that comparison,
from what I have understood today and what I understood before,
talking about prevention itself does not seem to be sufficient,
you have to talk about particular types of prevention, and also
those particular types of prevention within particular sub-populations,
the HIV community, if you like. In terms of broad-brushing I think
it is very hard to make that comparator. The other thing I would
say is, even where I have seen that preventive programmes do seem
to have some kind of impact in terms of clinical end points at
the end of the day there has been little information on the actual
cost-effectiveness of those treatments. Another thing I would
add is, I think intuitively prevention will always win through,
but at the same time there is clearly over 30,000 people in Britain
who are receiving HIV treatments or are eligible for HIV treatments—and
that number seems to be stable, or perhaps even increasing—I
am not too sure about that. It seems that there are still a sizable
number of people who will continue for some time to require treatment,
particularly as they are now living longer. Even though the intuitive
is to think in a data free zone is to think about prevention I
think for people who already have HIV should not be forgotten
and the treatments should still be funded on that basis
403. Okay. We talked about the differing views
on the role of PCTs, do you have any thoughts on where the resourcing
decision should be made? It is a very difficult one, because it
is an issue we touch on in every inquiry, how we determine who
gets the money, at what time and how we come to the decision?
Do you have any thoughts on the structures we now have that will
have a bearing on those decisions? Would you concur with some
of your colleagues concerns about the role of PCTs in this issue?
(Dr Miners) I am not sure if I am the best person
to answer that question, if I am honest. I think the role, if
you like, of technology appraisal is to provide information on
clinical cost-effectiveness and that various PCTs will always
face various decisions as to what they should fund. Going back
a step further I think it is very difficult to make those decisions
if that kind of information is not available I would almost go
back a step further and say we need to generate more robust evidence
before those decisions can be made.
Chairman: Okay. Excellent.
Julia Drown: I am aware of the time.
Chairman: We have kept you quite a long time
tonight. I do apologise for the fact we had to delay starting.
You are aware of the circumstances and what happened today was
beyond the control of this committee. I do apologise to you. It
has been a very interesting session, can I thank you for the contributions
all of you made and for your evidence. We are very grateful for
your help. Thank you very much.
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