HIV patients told to use cheaper drugs

HIV patients in London are being asked to help cut the £170million annual bill for their drugs by switching to cheaper alternatives.

The capital's 23 HIV clinics have been told to explain that NHS London needs to save money and that where possible people will be switched to cheaper antiretroviral drugs, to save £8million over two years.

However, some patients' groups fear there may be pressure to prescribe drugs which have more side effects and affect patients' quality of life.

The London HIV Consortium, which commissions HIV services for all 31 London primary care trusts, issued new guidelines which state that "using lower-cost alternatives that are clinically appropriate is entirely reasonable". They say clinicians should prescribe the right drug for the patient, but "discussing cost of drugs with patients is appropriate". The consortium is believed to have negotiated big discounts on ARV drugs with one or two pharmaceutical companies.

Dr Mike Youle, an HIV consultant at the Royal Free Hospital, said he was aware some clinicians were facing pressure to switch as many patients as possible to cheaper drugs. "I wouldn't be prepared to switch a patient doing well on one drug to a cheaper one simply for reasons of cost," he said.

Patients' advocates from UK-CAB, a network of HIV support groups, have met the consortium to express their concerns about the guidance which they claim alters the drugs most HIV patients start treatment with, and could require almost 3,000 people, who are stable, to switch drugs.

One patient advocate said: "The NHS will not get the discounted price for a range of HIV drugs if targets for the number of patients on them are not met...the process could end up costing the NHS money if a company decides to increase its price in response to a diminishing market share."

Claire Foreman, lead commissioner of the consortium, said: "With the clinical outcomes of a number of these drugs now similar, doctors and patients can consider alternative treatments without compromising quality of care."