Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 400-403)



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.


  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.

previous page contents

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 2 September 2002