On 11 September, NHS England issued a policy statement for a single tablet, four-in-one HIV combination treatment called Stribild (also know as Quad).1
This is important as Stribild is the first HIV treatment to be reviewed under the new NHS structure for commissioning HIV care.
The commissioning position, effective from August 2013, states the following scenarios in which it will be routinely funded:
The four drugs in Stribild are an integrase inhibitor (elvitegravir 150 mg) a pharmockinetic booster (cobicistat 150 mg), FTC (emtricitabine 200 mg) and tenofovir DF (300 mg).
Stribild needs to be taken once-daily with food. It should not be started in patients with estimated creatinine clearance below 70 mL per minute.
For further details please refer to the full prescribing information and patient information leaflets on the EMA website.4
As the first new ARV to receive EU approval under the current NHS restructuring, this is broadly good news for HIV positive people.
It shows that a new treatment can be reviewed and available relatively soon after European approval. It also recognises that new drugs have more limited data and therefore the requirement for a case review, by a team with experience of complex cases, is also probably good.
It is likely that these recommendations were closely related to the negotiated price that is referred to in the document but not given. The UK list monthly price for Stribild is Â£1034.72 (ex-VAT) so the discounted price is likely to be significantly lower -- though the lack of transparency over actual drug costs is perhaps not in patient interests.
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