Dear Sir or Madam,

FREEDOM OF INFORMATION REQUEST

1) Please could you provide all background documents, advice etc,
behind the decision to allow anti-malarial drug
atovaquone/proguanil (Malarone) to be prescribed on the NHS by
certain PCTs in the London area.

2) Please confirm the list of PCTs which provide this service.

3) Is the HPA aware of any plans to extend this service to other
PCTs?

4) What is the cost for providing this service compared to the cost
of treating patients with malaria?

Please provide the information in electronic format if possible.

Yours faithfully,

Alex Skene

Dear Sir or Madam,

My apologies, I forgot to add the following to my request:

5) What is the distribution of malaria cases by PCT for the latest
year that figures are available?

Yours faithfully,

Alex Skene

Dear Mr Skene,

Thank you for your request for information on Malarone and NHS
prescriptions received on 20th May made under the Freedom of Information
Act 2000.

I have responded to your questions in the order that you raise them.

1) Please could you provide all background documents, advice etc,
behind the decision to allow anti-malarial drug
atovaquone/proguanil
(Malarone) to be prescribed on the NHS by certain PCTs in the
London
area.

This was not a decision made by the Health Protection Agency, indeed I
am advised that this predates the Agency's formation. The decision to
allow anti-malarials to be prescribed on the NHS by certain PCTs would
be through local arrangements between the PCT's concerned and the NHS.

In accordance with section 1 (1) (a) of the Act, which places a duty to
confirm or deny whether the information is held, I can confirm that the
Health Protection Agency does not hold this information.

2) Please confirm the list of PCTs which provide this service.

In accordance with section 1 (1) (a) of the Act, which places a duty to
confirm or deny whether the information is held, I can confirm that the
Health Protection Agency does not hold this information. However, from
another source, I understand that it applies in Lambeth, Southwark and
Lewisham, you would need to contact the PCTs directly to confirm this.

3) Is the HPA aware of any plans to extend this service to other
PCTs?

In accordance with section 1 (1) (a) of the Act, which places a duty to
confirm or deny whether the information is held, I can confirm that the
Health Protection Agency does not hold this information.

4) What is the cost for providing this service compared to the cost
of treating patients with malaria?

In accordance with section 1 (1) (a) of the Act, which places a duty to
confirm or deny whether the information is held, I can confirm that the
Health Protection Agency does not hold this information. However, the
following extract from the British Medical Journal may be of interest.

BMJ. 1994 Oct 8;309(6959):918-22.

Comment in:
BMJ. 1995 Feb 11;310(6976):401-2. BMJ. 1995 Feb 11;310(6976):402.
BMJ. 1995 Feb 11;310(6976):402. BMJ. 1995 Jan 7;310(6971):61. BMJ.
1995 Jan 7;310(6971):61-2.

Is travel prophylaxis worth while? Economic appraisal of prophylactic
measures against malaria, hepatitis A, and typhoid in travellers.

Behrens RH, Roberts JA. Hospital for Tropical Diseases Travel Clinic,
London.

OBJECTIVES--To estimate the costs and benefits of prophylaxis against
travel
acquired malaria, typhoid fever, and hepatitis A in United Kingdom
residents
during 1991. DESIGN--Retrospective analysis of national epidemiological
and
economic data. MAIN OUTCOME MEASURES--Incidence of travel associated
infections in susceptible United Kingdom residents per visit; costs of
prophylaxis provision from historical data; benefits to the health
sector, community, and individuals in terms of avoided morbidity and
mortality based on hospital and community costs of disease. RESULTS--The
high incidence of imported malaria (0.70%) and the low costs of
providing chemoprophylaxis resulted in a cost-benefit ratio of 0.19 for
chloroquine and proguanil and 0.57 for a regimen containing mefloquine.
Hepatitis A infection occurred in 0.05% of visits and the cost of
prophylaxis invariably exceeded the benefits for immunoglobulin
(cost-benefit ratio 5.8) and inactivated hepatitis A vaccine
(cost-benefit ratio 15.8). Similarly, low incidence of typhoid (0.02%)
and its high cost gave whole cell killed, polysaccharide Vi, and oral Ty
21a typhoid vaccines cost-benefit ratios of 18.1, 18.0, and 22.0
respectively. CONCLUSIONS--Fewer than one third of travellers receive
vaccines but the total cost of providing typhoid and hepatitis A
prophylaxis of 25.8m pounds is significantly higher than the treatment
costs to the NHS (1.03m pounds)of cases avoided by prophylaxis. Neither
hepatitis A prophylaxis nor typhoid
prophylaxis is cost effective, but costs of treating malaria greatly
exceed costs of chemoprophylaxis, which is therefore highly cost
effective.

5) What is the distribution of malaria cases by PCT for the latest year
that figures are available?

In accordance with section 1 (1) (a) of the Act, which places a duty to
confirm or deny whether the information is held, I can confirm that the
Health Protection Agency does not hold these data by PCT. However, the
national data for 2007 are attached.

Please contact me if you would like any clarification.

Kind regards,

George

George Stafford
Head of Public Information Access
Health Protection Agency - Communications Division
61 Colindale Avenue, London NW9 5EQ

Direct Dial: +44 (0)20 8327 6629
Fax: +44 (0)20 8327 6633
Email: [email address]

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Dear Mr George,

Many thanks for the information and your assistance.

Yours sincerely, Alex Skene