Haemophiliacs' choice depends on postcode

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Treatment for haemophiliacs presently "depends upon the patient's postcode" and the Department of Health must take action to deal with this, experts warned yesterday.

In a letter to the British Medical Journal the UK Haemophilia Centre Directors Organisation (UKHCDO) urged the Government to ensure such patients are treated fairly and not "abrogate its responsibility".

At present some haemophiliacs are treated with recombinant Factor VIII, a purer, artificial form of the clotting agent, rather than the cheaper, plasma-derived version made from treated human blood which carries a higher risk of viral infection.

Doctors generally agree that recombinant Factor VIII is preferable on clinical grounds to plasma-derived Factor VIII for all haemophiliacs, but especially for children.

Last month four boys unsuccessfully took their local health authorities to the high court after they refused to fund the recombinant treatment.

Dr Christopher Ludlam, chairman of the UKHCDO said that the group had advised that recombinant should be used, particularly for babies and children who were not infected with hepatitis C. But he added: "The implementation of the guideline recommendations ... has been variable."

In the south of England, Scotland and Northern Ireland recombinant Factor VIII is becoming available for high priority patients, In the north of England some directors of public health are willing to fund it, while neighbouring authorities are not. "Treatment choice depends on a patient's postcode. There are thus widely divergent arrangements for treatment with a drug that is perceived by physicians, patients and parents alike to be safer."

Dr Ludlam said that health authorities had frequently made funding decisions which were "arbitrary" and that the DoH had "not so far provided any evidence to UKHCDO to indicate rFVIII should not be the treatment of choice."

Calling for dialogue between the directors and government, he added that the department should provide leadership on how the guidelines should be implemented. "To leave the decision to the apparent vagaries of local purchasers is to abrogate its responsibility for an important aspect of health care."

A spokesman for the Haemophilia Society welcomed the letter and "fully supported the suggestion that dialogue should be established between UKHCDO and the Department of Health".

In the early 1980s 1,200 haemophiliacs were infected with HIV from contaminated plasma-derived Factor VIII. Around 3000 - out of a total of 5,000 haemophiliacs in the UK - have been infected with hepatitis C.

The UK's use of recombinant is between 4-10 per cent of all Factor VIII given. It can cost twice as much as the plasma-derived product, and if a health authority refuses to pay for it, a doctor has little choice but to prescribe the less safe product.