NHS England stalls plans for HIV prevention drug

[garbon]

You can DECIDE to have very low exposure to HIV.

True, I can decide to abstain from sex. Not likely but I could do, I suppose.

[Fate]

Given that it is a system that frowns in general on annual health checks, I shouldn't be surprised that it's preventative medicine clings to the dark ages.

Annual healthcare checks are frowned upon in the United States as well and are quite controversial with the big medical societies. They don't lower mortality. If you have a problem, go see a doctor. There are specific times for screening tests, but it's nowhere near yearly.

[Berkut]

If it is so expensive, I am quite sure there are more pressing health issues to spend NHS money on. I mean it is pretty well known how you can prevent/minimise your chance of getting AIDS, but there are other expensive and severe diseases/conditions to which exposure is not optional.

Yes, probably better for the NHS to just bear the cost of paying for someone once they contract HIV as it'll surely be cheaper to cover medication once that happens...oh wait it isn't.

Well, from a strictly financial perspective, is it more costly to provide the preventive treatment to some number of men than it is to provide HIV treatment to the 2500/year who get the disease?

And will that 2500 go down a lot with the preventive treatment? What about other treatments for STDs that will inevitably increase if everyone thinks that taking this drug means they don't need to use condoms anymore?

I don't think the cost/benefit analysis is as simple as we think.

Truvada is due to come off patent. Already an Indian manufacturer's generic is 1/7th the cost of the branded version - a price which would only continue to drop with patent expiry and pressure from the NHS on drug manufacturer costs.  On the flipside, most patients with HIV are on a cocktail of expensive drugs as well as require more time from doctors and hospitals to treat their condition.

It would be a mistake of anyone using condoms to think that PrEP will be a replacement as it isn't as effective and is intended for use with condoms.

I suspect that it will in fact be a mistake made by many, and you have to analyze that and account for it in budgeting.

I don't doubt that treating HIV is vastly more expensive on a case by case basis, but there will be an order of magnitude or more people needed preventive treatment than people needing actual treatment, and it is entirely possible, if not likely, that the widespread use of this drug will increase incidents of other STDs.

[garbon]

Given that it is a system that frowns in general on annual health checks, I shouldn't be surprised that it's preventative medicine clings to the dark ages.

Annual healthcare checks are frowned upon in the United States as well and are quite controversial with the big medical societies. They don't lower mortality. If you have a problem, go see a doctor. There are specific times for screening tests, but it's nowhere near yearly.

I've never had a doctor turn me away when I've asked for a regular check-up. Not the case here where if I want an appointment, I need to present with an issue.

Also, when I go to the doctor it isn't solely about trying not to die - it is about quality of life too.

[Fate]

Given that it is a system that frowns in general on annual health checks, I shouldn't be surprised that it's preventative medicine clings to the dark ages.

Annual healthcare checks are frowned upon in the United States as well and are quite controversial with the big medical societies. They don't lower mortality. If you have a problem, go see a doctor. There are specific times for screening tests, but it's nowhere near yearly.

I've never had a doctor turn me away when I've asked for a regular check-up. Not the case here where if I want an appointment, I need to present with an issue.

Also, when I go to the doctor it isn't solely about trying not to die - it is about quality of life too.

Of course they're going to take your money. But the annual visit/physical is a medical anachronism. The vast majority of 18-50 year olds don't need to go to the doctor yearly unless they have specific complaints. Visits determined by evidence based health screening are appropriate. But there's no evidence we improve quality of life or general health by indulging the worried well.

[crazy canuck]

Given that it is a system that frowns in general on annual health checks, I shouldn't be surprised that it's preventative medicine clings to the dark ages.

Annual healthcare checks are frowned upon in the United States as well and are quite controversial with the big medical societies. They don't lower mortality. If you have a problem, go see a doctor. There are specific times for screening tests, but it's nowhere near yearly.

I've never had a doctor turn me away when I've asked for a regular check-up. Not the case here where if I want an appointment, I need to present with an issue.

Also, when I go to the doctor it isn't solely about trying not to die - it is about quality of life too.

If you dont have a medical issue or concern, why are you going to see your doctor?  For the fun of it?

[Eddie Teach]

If you dont have a medical issue or concern, why are you going to see your doctor?  For the fun of it?

Who doesn't have medical issues or concerns?

[crazy canuck]

If you dont have a medical issue or concern, why are you going to see your doctor?  For the fun of it?

Who doesn't have medical issues or concerns?

I don't know.  But presumably people who have them go to see their doctor rather than going when they don't.

[Eddie Teach]

But presumably people who have them go to see their doctor

[viper37]

If it is so expensive, I am quite sure there are more pressing health issues to spend NHS money on. I mean it is pretty well known how you can prevent/minimise your chance of getting AIDS, but there are other expensive and severe diseases/conditions to which exposure is not optional.

Yes, probably better for the NHS to just bear the cost of paying for someone once they contract HIV as it'll surely be cheaper to cover medication once that happens...oh wait it isn't.

Well, from a strictly financial perspective, is it more costly to provide the preventive treatment to some number of men than it is to provide HIV treatment to the 2500/year who get the disease?

And will that 2500 go down a lot with the preventive treatment? What about other treatments for STDs that will inevitably increase if everyone thinks that taking this drug means they don't need to use condoms anymore?

I don't think the cost/benefit analysis is as simple as we think.

Depends if you analyze the costs strictly for the government arm responsible for health funding.
Yeah, it might be more cost effective to treat the sick rather than prevent the disease.
However, as integrated public policy, preventive medicine over a long period is usually less costly (vaccines), than treating diseases (a flu epidemic/pandemic could cripple many health care systems).

[viper37]

If you dont have a medical issue or concern, why are you going to see your doctor?  For the fun of it?

It's called regular health check-ups.  You don't have those in BC?  See your doc once a year or per two years, have blood tests, urine sample, etc, just to see if something wouldn't show up in its early stages.

[crazy canuck]

If you dont have a medical issue or concern, why are you going to see your doctor?  For the fun of it?

It's called regular health check-ups.  You don't have those in BC?  See your doc once a year or per two years, have blood tests, urine sample, etc, just to see if something wouldn't show up in its early stages.

As our Resident Doctor (see what I did there  ) has said, that is not the prevailing view.  Instead healthcare has shifted to screening during particular periods in life. There is really no reason for an otherwise healthy person in their 20s or 30s to see a doctor on a regular basis just to say hi.

[garbon]

Well to toss him under the bus - isn't this the same person who said Zika didn't have a link to microencephaly?

[garbon]

Given that it is a system that frowns in general on annual health checks, I shouldn't be surprised that it's preventative medicine clings to the dark ages.

Annual healthcare checks are frowned upon in the United States as well and are quite controversial with the big medical societies. They don't lower mortality. If you have a problem, go see a doctor. There are specific times for screening tests, but it's nowhere near yearly.

I've never had a doctor turn me away when I've asked for a regular check-up. Not the case here where if I want an appointment, I need to present with an issue.

Also, when I go to the doctor it isn't solely about trying not to die - it is about quality of life too.

If you dont have a medical issue or concern, why are you going to see your doctor?  For the fun of it?

Well I've a family history (on both branches) of mental illness, diabetes, high cholesterol and high blood pressure. Having gone through mental illness and disability, I think it would have been preferable if it had been caught sooner and not just left to when I decided it was significant enough of an issue to seek help.

[Admiral Yi]

Well to toss him under the bus - isn't this the same person who said Zika didn't have a link to microencephaly?

He said it was plausible that the observed correlation was a result of omitted variable bias.