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Government rips up blank cheque on cancer drugs

Published on 28/08/14 at 08:30am
British prime minister David Cameron launched the CDF in 2010

Pharma has priced itself out of the Cancer Drugs Fund as the rising costs of its new oncology treatments sees Whitehall getting tougher with the industry.

In response, the British government has announced today that it will be extending the annual spend on the Cancer Drugs Fund (CDF) from £200 million a year to £280 million a year to accommodate the inexorable rise of cancer drug costs.

But where once the CDF would pay for any drug at any price, each medicine will now be scrutinised for its cost-effectiveness, and it will not pay out for medicines deemed too costly.

So depsite the extra £160 million, the government will still need to tighten its belt for new patients using the Fund from now until 2016, given the 9% increase in cancer patient diagnoses since 2010, and the large increases in oncology drug costs year-on-year.

The money from the CDF pays for new oncology drugs not recommended by the cost-effectiveness body NICE, or are under appraisal from the watchdog. The Fund will have paid more than $1 billion from its start date in October 2010 to its current end date of March 2016.

NHS England, which effectively runs the health service, will now negotiate with the pharma industry on cost to “ensure best value for the NHS” to help keep the Fund sustainable.

But this will turn the entire process into a Heath Robinson system, whereby NICE rejects a new cancer drug, it is then referred to the CDF, but then it is also deemed not cost-effective here either, and will not be available to patients unless pharma backs down on price – exactly the process that NICE currently employs.

In a statement the Department of Health says NHS England are now working with NICE, researchers and patient charities to “examine the wider process by which the way the NHS makes commissioning decisions on new cancer drugs”.

It also says that it will remove the ‘least clinically effective’ medicines from the CDF list.

The CDF is meant to be axed in two years, but the DH says that longer term it will ‘consider carefully’ with NHS England the ‘best course of action’ for the Fund in the future.

But this uncertainty is irking some, including Chris Askew, chief executive of Breakthrough Breast Cancer, who says: “This is good news for patients because the Cancer Drugs Fund remains the only way that they can access expensive but effective cancer treatments that NICE cannot approve.

“However, we remain concerned that this is not a long-term solution to the problem of access to drugs that currently exists in the UK.”

Currently cancer drug specialist Roche makes the most from the Fund, taking around a quarter (£50 million) of all spending each year since 2010, predominately for its older multi-cancer drug Avastin (bevacizumab), which has been continually knocked back by NICE.

In fact the Swiss firm landed in hot water earlier this month after refusing to drop the price on its new breast cancer drug Kadcyla (trastuzumab emtansine) any lower, meaning NICE rejected the treatment given its £90,000 price tag.

Kadcyla can be used via the CDF, but it is uncertain whether it will now also come under greater scrutiny before being given to new patients.

The government also announced in April that it would shell out nearly £19 million for a new silo fund for Gilead’s hepatitis C pill Sovaldi (sofosbuvir), in combination with the firm’s other antiviral ledipasvir.

NICE is now recommending the treatment for NHS funding in draft guidance issued in August, meaning this silo fund will soon be stopped.

Standing up to pharma

Speaking on the BBC’s Newsnight programme before the announcement, the prominent pharmacologist David Colquhoun says the CDF has been brought about by ‘political pressure’. He goes on: “It’s enormous this pressure and it’s brought by pharma and by patient organisations, which are often just fronts for a pharma company.”

Oncologist Dr Karol Sikora says today’s announcement is the government “standing up to pharma on pricing”.

He adds that the situation is a strange one, as: “You have NICE, which is an assessor on cost who turns a new drug down, but then the government gives pharma a back door to get into the NHS.

“But that back door is only there to stop politicians losing face, especially as we are in the run up to the General Election [in May 2015].”

Colquhoun adds: “Axing the Fund is the only way to go – you have to stand up to these companies and I believe they will probably back down in the end, but it won’t be easy.”

Ben Adams

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