Spending watchdog recommends against rolling out HIV prevention jab on the NHS
Charities said they were “profoundly disappointed” by the move
The NHS spending watchdog has recommended against rolling out a twice yearly injection that protects against HIV on the health service.
The cost-effectiveness estimates around lenacapavir are “above that range” considered an “acceptable use of NHS resources”, according to the National Institute for Health and Care Excellence (Nice).
There were also “uncertainties in the clinical evidence”, its draft guidance said.
Charities said they were “profoundly disappointed” by the move and urged Nice to “get around the table” with NHS England and the drug’s manufacturer to find a solution.
Lenacapavir is a type of pre-exposure prophylaxis (PrEP), which are used to reduce the risk of getting HIV among those at a higher risk of the virus.
It is given as an injection once every six months.
PrEP is usually taken as a pill, often once daily, though some eligible people can have an injection of cabotegravir every two months.
New draft guidance from Nice said trials have shown lenacapavir reduces the risk of HIV more than oral PrEP, but it is uncertain how well patients involved in studies reflect the UK population.
It also said there are “uncertainties in the economic model” such as how many people would have the injection over pills.
The guidance said that “cost-effectiveness estimates are above the range that Nice considers an acceptable use of NHS resources”.
Richard Angell, chief executive of Terrence Higgins Trust, said: “We are profoundly disappointed by this initial decision by Nice.
“Twice-a-year injectable PrEP is the most exciting innovation in HIV prevention for years.
But history is repeating itself when it comes to PrEP access in England and Wales – clearly lessons haven’t been learned.
“PrEP is a game-changer for HIV prevention and innovations like this must be jumped on and maximised – not kicked into the long grass and squandered.”
Mr Angell also stressed that “new innovation” is needed if England is to end new HIV transmissions by 2030.
He urged Nice, NHS England and lenacapavir manufacturer Gilead to “urgently get around the table and find a solution”.
“Nice need a better approach to preventative medicine and be transparent about what needs to happen for it to recommend lenacapavir as PrEP, Gilead needs to move on price, and NHS England needs to be ready to order higher volumes,” Mr Angell said.
“The provision of twice-yearly injectable PrEP is crucial for properly maximising the potential of this game-changing HIV prevention tool, which has already had such a positive impact in this country as a pill.
“To date this has primarily been felt among gay and bisexual men, while the injectable option has proven an important innovation for enabling more women to protect themselves.
“The injectable is an important way of increasing choice, particularly for those who cannot take PrEP in pill form.
“It will also benefit those who struggle with adherence, especially those in our military, people who are homeless or living in unstable housing, and our prison population.
“Nice has assessed the current numbers for Lenacapavir provision and said no based on its criteria. But the reality is that we need this innovation to end new HIV cases by 2030 and ensure nobody and no community is left behind. The numbers need to change and fast.”