The EU is dragging it's feet on PrEP…

[rawTOP]

This is just sad… The EU apparently isn't convinced about PrEP…

http://www.aidsmap.com/European-CDC-cautious-about-PrEP/page/2891977/

The European Centre for Disease Prevention and Control (ECDC) has issued a paper saying that it cannot make a clear Europe-wide recommendation on the use of pre-exposure prophylaxis (PrEP), and that it would require clearer data on efficacy, cost-effectiveness, side-effects, resistance and its impact on condom use before making a recommendation.

I wonder if it's because if they back it the governments have to pay for it. Someone needs to show them that PrEP is cheaper than having guys become poz. But cost-effectiveness may only be achieved if the price of PrEP goes down.

[wood]

I wonder if it's because if they back it the governments have to pay for it. Someone needs to show them that PrEP is cheaper than having guys become poz. But cost-effectiveness may only be achieved if the price of PrEP goes down.

I suspect that this is almost entirely why they are taking longer to make a decision.

[Guest beezee]

I think it's because PrEP isn't cheaper than having guys become poz :-(. It relies on deciding who to give it to, adherence and whether it's worth the drop in condom use. No data on any of this in the European context = no recommendation. Seems fair to me.

ECDC are keeping an eye on developments but the only studies I know of in Europe won't report for years, so future seems bleak.

[NLbear]

The Dutch Aids Foundation has stated in 2012 that there were still too many questions about Truvada to release it on the market as medication to prevent HIV infection. They said Truvada could reduce the risk of getting infected "only" by 44 to 73%. They also stated then that the tight regime of taking medication every single day in combination with regular medical checks had proven to be difficult to keep up by (test) users.

Six days ago (July 17th 2014) they released a statement saying they support further investigation into the feasability of using PrEP for a specific target audience (men who have unprotected sex with multiple men or neg men with HIV+ partners) and will start a study on that later this year together with the Amsterdam Health Services (GGD) and other parties.

And yes, the EU is slow in making decisions. That's because there are 28 different countries in the EU, all with different social, cultural and religious backgrounds who all have to have their say. It's not a country. And I believe (but am not sure) that approving a certain type of medication to the EU market is an EU decision, not an invidual country decision (otherwise people would go shop around across the border). What is covered by health insurance though is a country decision, or even health insurance companies in that country. In Holland it wouldn't be the government that would have to carry the costs but insurance companies. But it differs per country depending of what their health care system is. I would assume (but Bearbandit knows this better than I) in the UK the NHS would have to pick up the costs.

In Holland I am sure there will be companies who will refuse to cover the costs as they will regard it as giving somone a free ticket (at their and premium payer's expense) to have unprotected sex. They will say that there is a cheaper alternative: condoms. Which are also not covered by the way, but less expensive than the $5k+ the ECDC expects the costs to be for PrEP per person. They will also argue that it is unfair that other premium payers would have to pay for a gay guy's "free ticket" to have unprotected sex while there is an alternative (condoms). Which of course will be odd because my premium now also pays for stuff my fellow premium payers use but I don't and never will: contraceptive pills, abortions, fertility treatments and so on.

[rawfuckr]

They will also argue that it is unfair that other premium payers would have to pay for a gay guy's "free ticket" to have unprotected sex while there is an alternative (condoms). Which of course will be odd because my premium now also pays for stuff my fellow premium payers use but I don't and never will: contraceptive pills, abortions, fertility treatments and so on.

The case for that is the same on being done in the USA. If the gay men end seroconverting, we all agree that the healthcare plans will have to pay for their life-long treatment, so avoiding infections could be cost effective after all. It really comes down to the efficacy of PrEP not proven to be close to perfect if one adheres daily and then of course how much you can get the population at risk to get the pill, which is a real challenge.

Does anyone have any idea when Truvada could go generic in Europe? In the USA I've heard sometime in 2017

[NLbear]

I agree the costs would be less to provide PrEP (if it would be 100% effective in prevention of contracting HIV) than providing drugs to keep a HIV+ patient alive, for the rest of their lives. But insurance companies are rats. At least in Holland they are not state controlled anymore, but private companies whose ultimate goal is to make a profit for the stakeholders. There is some government role in that government can order the sector to have a cap in premiums, but the whole privatization of health care in NL has been a total disaster.

Where years ago, when we had a different system (state provided for low income for low cost or private for those who could afford it) people now are furious about the selling out and privitization of services by the government that used to be state owned. Everything had to be privatized because that would improve competition and drive prices down, they said. The opposite has happened. This is not just health care, but in a lot of other areas. The Dutch fear they are going the "American way", where you can only have a good service as long as you have money. And the low paid people are left to rot in the streets because they cannot afford it (at least that is what I see on news sites comments.

We had a very good health care system but recent governments are breaking it down with the motto "competition will decrease the costs". Costs have only gone up since then. And politicians are doing the exact opposite of what they promised before the election as soon as they have a seat in parliament or government. I am totally disgusted. What worries me is that the majority still votes for those vultures.

Sorry for ranting.........

[wood]

I agree the costs would be less to provide PrEP (if it would be 100% effective in prevention of contracting HIV) than providing drugs to keep a HIV+ patient alive, for the rest of their lives. But insurance companies are rats. At least in Holland they are not state controlled anymore, but private companies whose ultimate goal is to make a profit for the stakeholders. There is some government role in that government can order the sector to have a cap in premiums, but the whole privatization of health care in NL has been a total disaster.

Where years ago, when we had a different system (state provided for low income for low cost or private for those who could afford it) people now are furious about the selling out and privitization of services by the government that used to be state owned. Everything had to be privatized because that would improve competition and drive prices down, they said. The opposite has happened. This is not just health care, but in a lot of other areas. The Dutch fear they are going the "American way", where you can only have a good service as long as you have money. And the low paid people are left to rot in the streets because they cannot afford it (at least that is what I see on news sites comments.

We had a very good health care system but recent governments are breaking it down with the motto "competition will decrease the costs". Costs have only gone up since then. And politicians are doing the exact opposite of what they promised before the election as soon as they have a seat in parliament or government. I am totally disgusted. What worries me is that the majority still votes for those vultures.

Sorry for ranting.........

Ehhh yeah that sucks. Its great that PrEP is available in america, but i suspect that even if America had a single payer system there would still be PrEP. Americans LOVE medication as a solution.

As for the healthcare system in Holland, yeah its a awful always wrong argument that competition will drive down costs in healthcare, even the "non profit" healthcare systems desire to make money to expand, and it only increases costs on consumers.

In contrast, countries that have some level of universal healthcare usually have lower costs.

http://en.wikipedia.org/wiki/Universal_health_coverage_by_country

Edited July 24, 2014 by wood

[NLbear]

Thanks for that. We DO have an universal Healthcare system. Insurance is mandatory or you will be fined. You can pick and chose between Healthcare companies but you have to have one.