Fight for fairness

Nuvaring availability a ‘postcode lottery’

Where you live can affect your access to a form of contraception, results from my survey of Primary Care Trusts (PCT) in England has shown.

The NuvaRing, which was approved by the National Institute for Health and Clinical Excellence (NICE) for use in January 2009, could be unavailable in nearly one third of PCTs in England.

These results were obtained by a survey of PCTs in England using Freedom of Information requests. The results shown in the Google map below are preliminary, as more responses are needed for a comprehensive overview of the situation.

The NuvaRing is a form of combined hormonal contraception which comes in the form of a vaginal ring. This is left in for three weeks, and then removed for a week to allow a withdrawal bleed (similar to the pill) before another ring is inserted.

It has become clear during this investigation that the NuvaRing is still being considered for inclusion on formularies in many areas. Some PCTs can give no time frame for when a decision will be made and many do not expect a decision to be made for many months.

The reasons given for this are varied. They include a lack of information regarding where funding will come from and very frequently, a lack of demand for the product. In the case of Trafford PCT, the drug has been clinically approved but ‘financial concerns have not been resolved’.

Cost concerns arise again, even where the NuvaRing is available. Nearby Manchester’s PCT warned, ‘We advocate principles of cost effectiveness and where applicable this may mean using the drug of the lowest acquisition cost.’

The NuvaRing costs, on average, £9 a month. This figure is ‘comparatively expensive’  compared to combined contraceptive pills, which vary in cost but average a couple of pounds a month. However, it is by no means the most expensive form of contraception a couple can opt for. The new ‘morning after pill’ or ‘Plan B’, Ellaone which was launched in the UK in October 2009 costs £16.95 per dose and costs three times as much as Levonorgestrel . Implanon, one of the LARCs being recommended costs the NHS £79.46 (correct April 2009) , which is cost effective if used for 3 years, but if removed sooner than a year can prove far less cost effective than the contraceptive pill. Though of course, these figures do not take into account the cost of a pregnancy, unintended or otherwise.

All contraception is available free of charge to patients in the UK on the NHS.

Since 2005 NICE has recommended that all women requiring contraception should be offered a choice of all methods of contraception by their GP, including long-acting reversible forms of contraception (LARCs). Last year in 2009, the NHS introduced three new sexual health indicators into their Quality and Outcome Framework (QOF), which is a voluntary annual reward and incentive programme for all GP surgeries in England. These included:

• The percentage of women prescribed an oral or patch contraceptive method in the last year who have received information from the practice LARCs in the previous fifteen months and,
• The percentage of women prescribed emergency hormonal contraception at least once in the year by the practice who have received information from the practice LARCs at the time of, or within one month of, the prescription.

Currently, the NuvaRing does not count as a LARC under NHS guidelines, but one of the benefits of use is that user error is lower; you only have to remember to change it once a month rather than take a pill every day.

In order to fulfill the NICE guidelines laid out in 2005, the NHS launched the ‘Contraception – Worth talking about’ campaign in November 2009. It was revealed in written answers to questions submitted to the Health Secretary Gillian Merron in January 2010  that estimated advertising expenditure ‘to date’ was £1,218,000 and estimated advertising costs for further activity planned for February 2010 is approximately £1,513,000. Budgets for 2010-11 and 2011-12 are currently under review.

Although some PCTs cite a lack of demand for the NuvaRing (for example in Redbridge and South Staffordshire PCTs no application had been made for the NuvaRing), South and Eastern Kent PCT reports 60 being prescribed in the last financial year.

One further problem associated with the NuvaRing is that it requires storage in a fridge. Some PCTs claim they do not have storage available for the product.

While some PCTs have banned the prescription of the NuvaRing by coding it RED or RED RED on their formularies, other PCTs have made it available to women who are unsuitable candidates for other available forms of contraception. Surrey PCT resported, in response to the FOI request submitted that, ‘The Medicine Management sub–committee (May 2009) agreed that Nuvaring® may be of benefit in a small number of patients and therefore should be available to patients in family planning clinics where other treatments are not suitable.’

I await further information to add to this investigation.

* You can become part of this investigation here.

NuvaRing investigation: Google map

Above is a map showing the results, so far, of my investigation into the availability of the NuvaRing in England, by Primary Care Trust (PCT).

• Red signifies a PCT where the NuvaRing is not available.
• Yellow signifies a PCT where the NuvaRing is available with restrictions.
• Green signifies a PCT where the NuvaRing is available.

The responses are available where appropriate for you to peruse.

It has become clear during this investigation so far,  the NuvaRing is still being considered for inclusion in many areas. Some can give no time frame for when a decision will be made and many do not expect a decision to be made for many months.

The reasons given for this are varied. They include a lack of information regarding where funding will come from and very frequently, a lack of demand for the product. In the case of Trafford PCT, the drug has been clinically approved but ‘financial concerns have not been resolved’.

Cost concerns arise again, even where the NuvaRing is available. Nearby Manchester PCT warned, ‘ We advocate principles of cost effectiveness and where applicable this may mean using the drug of the lowest acquisition cost.’

Although some PCTs cite a lack of demand for the NuvaRing (for example in Redbridge and South Staffordshire PCTs no application had been made for the NuvaRing), South and Eastern Kent PCT reports 60 being prescribed in the last financial year (the NuvaRing became available in January 2009).

I await further information to add to this investigation.

NuvaRing investigation: Background information

An article from Pulse from October 2008 caught my attention today. The article, (here), outlined how plans were made as far back as 2008 to aline LARC availability with NICE guidlines.

They also suggest offering 3 QOF points to surgery’s offering all available contraception to women, including LARCS, amoung other measures.

Experts back HPV test for cervical smears

Experts have shown that HPV testing instead of cervical smears may be the best first line of defence in cervical screening.

Results published in the Lancet Oncolcogy showed HPV testing could reduce the number of cervical screenings which a woman need to attend. Researchers compared HPV testing with cytology in 81,220 women aged 25 to 60. In the second round of testing,  done in women who had tested positive for HPV, nine invasive cancers were found in the cytology group.

Combining HPV and cytology testing did not improve sensitivity, suggesting HPV testing alone was responsible for the increased detection of abnormalities.

However, switching to HPV testing will only be recommented for women over the age of 35, as in the  younger age group, HPV testing led to an over-diagnosis of regressive lesions, which, if treated surgically, can cause problems during pregnancy.

Professor Kitchener, who chairs the UK’s cervical screening advisory group, said in Pulse magazine: ‘In an era with a vaccinated cohort of women, there is a higher chance women will test negative for HPV and you can confine cytology to women who are HPV positive.

Investigation: Help needed

The NuvaRing, a new form of contraception, was launched in the UK in January 2009 after it was approved by NICE. However, it has become apparent that nearly one year after it was launched many PCTs in the country have listed this form of contraception as RED RED, RED orAMBER on their formularies (a list of which drugs are available to patients) meaning it is unavailable unless a doctor requests it specifically for a patient from the PCT. This is normally only done when there are health risks associated with the patient not receiving a drug.

In the past 18 months there has been increasing pressure to increase the availability of different forms of contraception on the NHS, specifically LARCs (long acting reversible contraception). The NuvaRing is unique in that it lasts a month, and is completely reversible. I has been launched in the US and has become increasingly popular.

I have started an investigation to find out how many PCTs in England and Wales have not made the NuvaRing available to patients. I want to find out which ones have branded it Amber, Red or Red Red and why.

I have left Scotland out of this investigation as the rules concerning formularies are different and it was launched there at a different time.

Here’s how you can help:

Call up your local PCT and ask them how the NuvaRing is branded in your area. Information can be found here.

Call up your local family planning clinic and ask if and how you can access it.

If you have had any problems or have not been happy with your access to contraception via the NHS, please leave your comments below.

Please send any information to hannahbflynn@googlemail.com

Blog Action Day 2009

To celebrate Blog Action Day 2009, here are two of my articles which were published on the interweb today:

An explanatory introduction to the UN Climate Conference, COP-15 in Copenhagen, published by IslamOnline.com: http://twurl.cc/1q89

A news story on the aquisition of Solel by Siemens, an important step for solar thermal technology, published by RenewableEnergyWorld.com: http://twurl.cc/1q8a

10 reasons you should have the HPV vaccine

Following the tragic death of a fourteen year-old girl just two hours after receiving the HPV vaccine as part of the UK’s policy to vaccinate all girls under 18, the media has been awash with confused stories regarding the safety of the jab.

The first stages of the postmortem showed she had an underlying health problem, most likely a heart defect which would commonly present for the first time at this age, which was the cause of her sudden death.

However, when the story broke, before the first results from the postmortem became available the media insinuated the HPV vaccine may have caused in her death. 

It is important we do not have a vaccination scare on the scale of the MMR, and young girls (and perhaps their families) are comfortable receiving this potentially life saving jab.

Therefore, here are ten reasons you should have the HPV vaccine:

1. It protects against the two types of HPV which cause 70% of cervical cancers.

2. Women have, on average, a 1.6% chance of developing cervical cancer in their life time; there is less than a 1 in a million chance of severe anaphylaxis due to this vaccine (3).

3. Cervical cancer kills 1,000 women every year in the UK. It is thought the vaccination programme could save 400 of them.

4. The risks are low. All vaccines carry risk, but the HPV vaccine has shown few contraindications. The most common side effect is ‘sore arm’.

5. 50% of sexually active women contract HPV by the time they are 30 .

6. Sexually transmitted diseases are on the rise which can increase your susceptibility to HPV and increase your risk of cervical cancer up to six times (1). For example, women who also have genital herpes are more likely to get more invasive forms of cervical cancer (2).

7. Cancer is a killer, but not only that. Treatment for cervical cancer can include surgery and chemotherapy which can leave you infertile, or with difficulty conceiving. This has happened to many women in their twenties.

8. We need as many people as possible to be vaccinated in order to reduce the prevalence of HPV in the population. Normally, vaccination programmes require 80% of the whole population (men included) to be vaccinated in order to eliminate a disease.

9. Promiscuity alone does not cause cervical cancer, as one third of women with only one sexual partner contract HPV within one year. As previously mentioned, 50% of women have been exposed to HPV by the time they are 30.

10. The NHS (and many other health authorities) have emphasised the importance of, and have promised to continue cervical screening. But there is no reason to not use belt and braces girls!

1. P Koskela, T Anttila, T Bjørge, A Brunsvig. (2000). Chlamydia trachomatis infection as a risk factor for invasive cervical cancer.International journal of cancer.

2. 2003. Cervical cancer risk rises if women with HPV also have herpes infection. International Family Planning Perspectives

3.  D. Cooper, (2007). Determinants of sexual activity and its relation to cervical cancer risk among South African Women. BMC Public Health

World Contraception Day

Ahead of World Contraception Day this Saturday 26 September, a number of studies have come out to hammer home the safe sex message.

Lloyds Pharmacy’s latest research shows the average British adult has indirectly had sex with 2,881,024 people. This shocking statistic is based on the average British adult having sex with 7.65 people in their life time.

 “When we have sex with someone, we are, in effect, not only sleeping with them, but also their previous partners and so on,” Clare Kerr, head of sexual health for the chemist chain,  as reported in the Metro today.

 You can calculate your own figure using the tool on their website.  This will base your answer on your age, your number of sexual partners and the age that they were.

 In a similar vein, the Australian publication, Pharmacy News reported an alarming number of women are ignorant of the potential threat to their health and the risk of pregnancy which can result from unprotected sex.

 The research was commissioned by Sexual Health and Family Planning Australia (SHFPA) and Bayer Schering and they found two out of three adult women admitted to having unprotected sex.

SHFPA’s Dr Christine Read said, “It’s worrying that young women continue to engage in unprotected sex, but it is equally concerning that many women don’t have basic knowledge of their menstrual cycle. For example, many women don’t realise they can get pregnant even if they have unprotected sex outside the time they’re ovulating.”

Dr Read went on to say that women taking hormonal contraceptive pills should be given more information about how to take them properly.

Today Conceptus, a company engaged in women’s health care recognised World Contraception Day. This year’s motto is “Your life, your voice: Talk Contraception.” One of the main focuses is encouraging more women to consider permanent forms of birth control.

15andcounting love Women’s Health Base!

This blog has been featured in the 15andcounting campaign’s blog.

They are a campaign group set up petition governments to make young people’s sexual health a policy priority and are well worth a look.