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Maintaining cost-effective access to antiretroviral drug therapy through a collaborative approach to drug procurement, consensus treatment guidelines and regular audit: the experience of London HIV commissioners and providers
  1. Claire Foreman1,
  2. Brian Gazzard2,
  3. Margaret Johnson3,
  4. Peter Sharott1,
  5. Simon Collins4
  1. 1London Specialised Commissioning Group, London, UK
  2. 2HIV/GU Unit, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  3. 3Ian Charleson Day Centre, Royal Free Hampstead NHS Trust, London, UK
  4. 4HIV i-Base, London, UK
  1. Correspondence to Claire Foreman, Senior Commissioning Manager, London Specialised Commissioning Group, Portland House, Stag Place, London SW1E 5RS, UK; claire.foreman{at}


Background In the UK, meeting the £20 billion efficiency challenge in the NHS requires new approaches to protect quality and improve productivity. In London, clinicians, people living with HIV and commissioners are collaborating to reduce the cost of antiretrovirals as part of the Quality Innovation Productivity and Prevention agenda.

Objectives To describe how collaboration in antiretroviral procurement in 2011/2012 aimed to significantly reduce drug acquisition costs, ensure equity of prescribing and protect the quality and experience of care and treatment for patients.

Methods Greater clinical leadership and engagement and involvement of patient representatives enabled an approach to drug procurement focused on clinical outcomes at a patient and population level while reducing cost. Consensus guidelines for implementation were developed and agreed by all London lead clinicians while people living with HIV produced a patient information leaflet to explain the tender process and outcomes. A planned audit is underway at all services to monitor prescribing changes and outcomes for those on treatment.

Results HIV clinicians, pharmacists and patient representatives were directly involved in this novel therapeutic tendering approach to antiretroviral drug procurement. Modelling indicates that £8–£10 million savings will be released through the process over 2 years.

Conclusions Clinically led therapeutic tendering of antiretroviral drugs provides an opportunity to protect quality and improve productivity in HIV. The approach is novel in HIV in the UK, and the emergent learning has implications for quality and cost improvement in HIV spending in the UK and potentially in other countries.

  • Antiretroviral procurement
  • therapeutic tendering
  • cost-effectiveness
  • clinical engagement and leadership
  • QIPP
  • HIV therapeutics
  • HIV clinical care
  • HIV

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Commissioned; externally peer reviewed.

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