BACKGROUND

The number of people living with HIV (PLHIV) is increasing in the UK. This study estimated the annual population cost of providing HIV services in the UK, 1997-2006 and projected them 2007-2013.

METHODS

Annual cost of HIV treatment for PLHIV by stage of HIV infection and type of ART was calculated (UK pounds, 2006 prices). Population costs were derived by multiplying the number of PLHIV by their annual cost for 1997-2006 and projected 2007-2013.

RESULTS

Average annual treatment costs across all stages of HIV infection ranged from £17,034 in 1997 to £18,087 in 2006 for PLHIV on mono-therapy and from £27,649 in 1997 to £32,322 in 2006 for those on quadruple-or-more ART. The number of PLHIV using NHS services rose from 16,075 to 52,083 in 2006 and was projected to increase to 78,370 by 2013. Annual population cost rose from £104 million in 1997 to £483 million in 2006, with a projected annual cost between £721 and £758 million by 2013. When including community care costs, costs increased from £164 million in 1997, to £683 million in 2006 and between £1,019 and £1,065 million in 2013.

CONCLUSIONS

Increased number of PLHIV using NHS services resulted in rising UK population costs. Population costs are expected to continue to increase, partly due to PLHIV's longer survival on ART and the relative lack of success of HIV preventing programs. Where possible, the cost of HIV treatment and care needs to be reduced without reducing the quality of services, and prevention programs need to become more effective. While high income countries are struggling to meet these increasing costs, middle- and lower-income countries with larger epidemics are likely to find it even more difficult to meet these increasing demands, given that they have fewer resources.

http://sro.sussex.ac.uk/47545/1/journal.pone.0015677.pdf

Rising population cost for treating people living with HIV in the UK, 1997-2013.

Too soon to let it out of the lab

What do you call a government that embarks on the biggest upheaval of the NHS in its 63 year history, at breakneck speed, while simultaneously trying to make unprecedented financial savings? The politically correct answer has got to be: mad.

The scale of ambition should ring alarm bells. Sir David Nicholson, the NHS chief executive, has described the proposals as the biggest change management programme in the world—the only one so large “that you can actually see it from space.” (More ominously, he added that one of the lessons of change management is that “most big change management systems fail.”1) Of the annual 4% efficiency savings expected of the NHS over the next four years, the Commons health select committee said, “The scale of this is without precedent in NHS history; and there is no known example of such a feat being achieved by any other healthcare system in the world.”2 To pull off either of these challenges would therefore be breathtaking; to believe that you could manage both of them at once is deluded⇓.



Universal Pictures Company

Like all the other structural reorganisations of the NHS, this one aims to improve health outcomes. What’s lacking is any coherent account of how these particular reforms will produce the desired effects, a point only underlined by the prime minister’s attempts to justify the reforms earlier this week.3

This latest top down reorganisation has been whipped up in an awful hurry. It went unmentioned in the political manifestos of the coalition parties before the last general election, was specifically excluded in pledges given before and after the election, and didn’t make it into the Coalition Agreement of 20 May 2010. Yet less than eight weeks later, its outline emerged in the …

Dr Lansley's monster.

Since 2005, reforms in the National Health Service in England, overseen by the British government's Department of Health (DH), have further stimulated a market by increasing the number of providers and encouraging patient choice This study compares the DH's reporting until 2010, on its website, of ‘what patients want’ and the research evidence for its statements It will consider whether the evidence is more ambiguous than the website summary implied; obscuring the voices of those with opinions running counter to patient choice, as the DH defined it Finally, it reflects on whether there has been a subsequent change of approach

Choosing voices: the Department of Health's online interpretation of what patients want

The government’s proposals for yet another wholesale restructuring of the NHS have predominantly been greeted with scepticism by the media, the Labour opposition and NHS stake-holders. But drawing on his own experience in advising previous Labour governments, Julian Le Grand argues that Andrew Lansley’s proposals mainly represent a sensible evolution of previous strategies, while also advancing choice and competition further in key respects that have not yet been attempted.

Greater choice and competition in the NHS now provides a mature set of solutions whose time has come

/pdf/a-really-useful-editorial-155yrelntw.pdf

A really useful editorial

We asked a range of commentators from clinicians to academics to comment on the white paper on health Equity and excellence: liberating the NHS. Has the NHS become “a huge laboratory for some dodgy experiments,” in the words of one commentator; will the white paper divide the medical profession, as another claims; or will it simply empower doctors?

/pdf/white-paper-more-brickbats-than-bouquets-48t2xxdqcv.pdf

White paper More brickbats than bouquets

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White paper More brickbats than bouquets