The True Cost of HIV Treatment

Last week saw the first pre-election debate between the leaders of major UK political parties. Seven were invited: Conservative, Labour, Liberal Democrat, Greens, UKIP, Plaid Cymru and the SNP, resulting in a set that looked like a strange, suited parody of a quiz show. No one is sure who really won, and we won’t find out what the nation really thinks until the 7th of May, when the election is due to be held.

Despite having no clear winner, one soundbite emerged from the chaos: Nigel Farage’s assertion that foreigners make up most of the new diagnoses of HIV in the UK, at the cost of £25,000 each per year. For those of us following the pattern of gaffes and trip-ups occurring in the UKIP camp, this statement is one to add to that long list.

The truth is somewhat more complicated. HIV treatment is dependent on stage and resistance patterns, so an average is not really reflective of the true financial burden. Nevertheless, the MEDFASH HIV Standards of Care helpfully costed the average lifetime cost of treatment to be between £135,000 and £181,000, with an average cost of service provision for those on HAART at £15,000. The overall cost of HIV treatment is rising, due to the longer survival times, but the provision of antiretroviral treatment has been shown to be cost effective. Between £4,000 to £13,000 can be saved in indirect costs when HIV progression is halted.

With regard to the HIV diagnoses in the UK, the Department of Health statistics show that in 2013 (which is the latest year data is available) 2292 new diagnoses were British (ie born in the UK) and 2698 new diagnoses were in people born elsewhere, so for once, he’s not wrong by a margin of around 400 people.

Subsequently, a YouGov poll of 1900 people suggested that around half agreed with Farage’s suggestion that immigrants should not have access to treatment on the NHS until they have spent 5 years in the country, and a similar number seemed to express agreement with his views on HIV treatment on the NHS, albeit with a very leading set of questions. The fact that the US has double the prevalence of HIV with a privatised healthcare system; however, would suggest that this is perhaps not the greatest public health plan. There are still a quarter of HIV infected people in the UK unaware of their diagnosis, potentially spreading the virus to others without realising. If this is the situation with free testing and treatment, one wonders what effect of marginalising and stigmatising the diagnosis as a burden on the NHS will have.