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Cancer Drugs Fund ‘not sustainable in current form’

Published on 17/09/15 at 09:53am
More than 10,000 people were able to access Roche's Avastin through the fund between 2013 and 2015

The Cancer Drugs Fund has improved access to treatments, although the UK still lags behind other countries despite its ‘unsustainable’ cost, a report has found.

An investigation by the National Audit Office (NAO), an independent watchdog that scrutinises public spending, looked into questions about the “rationale for the fund and how it relates to mainstream NHS processes” that were identified during an NAO report on cancer outcomes and services published in January.

The investigation found that the fund has improved access to cancer drugs not routinely available on the NHS. From October 2010 to March 2015, over 74,000 patients were approved to receive drugs through the Fund. Between 2009 and 2013, use of new cancer drugs (defined as those launched in the previous five years) increased in the UK relative to the average in other comparable countries, although it remained below this average.

However the Cancer Drugs Fund (CDF) is vastly overspent. It was initially intended to run until March 2014 with a budget of £650 million, while Government, regulators and industry devised a long-term pricing mechanism for cancer and end of life treatments. However the fund has been extended until March 2016 and now has a total lifetime budget of £1.27 billion – already almost twice the original intended cost.

To rein back the costs of the fund NHS England has conducted two rounds of ‘de-listings’ to remove treatments from the fund. However NHS England now admits that despite these cuts it does not expect to avoid overspending on its budget for 2015-16, and that the first round of cuts did not save the £80 million that had been predicted.

Roche’s Avastin (bevacizumab) was the most commonly accessed drug in the fund in 2013/14 and 2014/15, and was provided for 10,720 people with breast, cervical, colorectal, ovarian cancer and gliomas.

It is not possible to evaluate the impact that the Fund has had on patient outcomes due to a lack of data – a situation that the chair of the Parliamentary Public Accounts Committee says ‘makes no sense’. NHS England and Public Health England signed a data sharing agreement in July 2015 to collect outcomes data for patients on treatments paid for by the Fund.

MP Meg Hillier, chair of the committee of public accounts, says “there needs to be much better control of costs and proper assessment of whether these drugs are making a difference to the health of patients.”

“NHS England spent £416 million on the fund in 2014-15, 48% more than planned, and neither the Department of Health nor NHS England knows what impact the Cancer Drugs Fund has had in extending the lives of the patients treated. Given the need to make informed choices about how to spend finite resources wisely, it makes no sense that the Department and NHS England lack the data needed to assess the effectiveness of the Cancer Drugs Fund and whether it is the best way to care for patients.”

NHS England has proposed that from April 2016 the Cancer Drugs Fund should become a managed access fund that pays for promising new drugs for a set period, during which NHS England would collect real-world evidence on the drug’s use and outcomes, before NICE decides whether or not the drugs should be recommended for routine commissioning. The proposals are due to be consulted on, and Meg Hillier called on “the Department of Health, NHS England, NICE and pharmaceutical companies now need to work together to ensure the Cancer Drugs Fund is sustainable and can deliver for the patients who need access to these drugs.”

The UK industry trade body welcomed the report. Dr Richard Torbett, the ABPI’s executive director of commercial, says: “Whilst the Cancer Drugs Fund improved patient access to cancer medicines that are not routinely available on the NHS, the report makes clear that the use of new cancer drugs in the UK still remains below the average in other comparable countries. We remain adamant that this needs to change.

“We want to see many more patients benefitting from new and innovative medicines, including cancer medicines, and we have long voiced the view that the Cancer Drugs Fund is not sustainable in its current form, as the NAO report highlights. What is needed is a wholesale reform of NICE, which, along with NHS England, needs to develop a longer-term sustainable solution to the evaluation and commissioning of cancer medicines.”

Lilian Anekwe

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