BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g5382 (Published 01 September 2014)
Cite this as: BMJ 2014;349:g5382
The Cancer Drugs Fund has been given a 40% increase in funding and has agreed to remove from its list any drugs that are overpriced or produce little clinical benefit. The fund’s chairman also promised to try to align the fund’s assessments more closely with those of the National Institute for Health and Care Excellence (NICE).
NHS England, which is responsible for the drugs fund, has agreed to increase the amount the fund receives for the next two years from £200m (€252m; $332m) to £280m a year. The fund has treated 55 000 people since it began, using drugs that NICE did not recommend as cost effective because, in most cases, they offered patients only a few more months of life.
Originally launched by Andrew Lansley, the former health secretary, as a way to satisfy political pressures,1 the fund has succeeded in that objective but has always been regarded by NICE and its supporters as something of a fudge: it covers only cancer, not other end of life conditions.
The major beneficiary of the fund (apart from the patients treated) has been the leading manufacturer of cancer drugs, Roche. The fund was originally meant to act as a bridge between the NICE dominated era—with its hard luck stories of patients denied drugs that were available in other countries—and a new era of value based pricing, where every new drug would carry a price tag that reflected its value. But that never happened, and instead the Pharmaceutical Price Regulation Scheme was renegotiated to set a global ceiling on drug spending. Every costly new drug sold to the NHS now means less money for other medicines.
This has driven a wedge between Roche—which was suspended from the Association of the British Pharmaceutical Industry (ABPI) in 2008 for breaching the rules and has never rejoined—and the rest of the industry. In the ABPI’s view the fund is no longer a cost-free offering. Its chief executive, Stephen Whitehead, welcomed the cash injection but warned, “However, it is only a short term solution and ultimately the NICE value assessment process needs to be reformed urgently, so that more innovative cancer medicines can be made available to NHS patients.”
The fund’s existence has eased the downward pressure on cancer drug prices, which NICE believes are too high. Roche’s latest breast cancer drug—Kadcyla, for advanced breast cancer—costs £90 000 for a course of treatment with outcomes that, under NICE rules, would make it worth £10 000 to £25 000. NICE rejected the drug on cost effectiveness grounds, but it is available through the Cancer Drugs Fund.
In a letter to NHS England the fund’s chairman, Peter Clark of the Clatterbridge Cancer Centre in Merseyside, said that the fund paid for drugs that showed good benefit but also for “minority drugs of much less clinical value.” He added that the fund had offered an alternative funding source “on price terms which in some cases have represented poor value.” He also undertook to review drugs and withdraw reimbursement for any found to be ineffective or too expensive. But this would not affect patients already taking those drugs or others that were the only confirmed treatment, he wrote. “The result will be to ensure patients continue to access worthwhile cancer medicines whilst also creating financial headroom for new medicines within the significantly expanded funding allocation,” he added.
The fund’s assessments will still diverge widely from those of NICE, despite Clark’s promise to try to ensure “greater alignment” between the two bodies. He also promised a new “evaluation through commissioning” option that would reimburse new drugs in clinical practice but would also review outcomes to assess value for money.
While the fund has made many drugs available to patients who would not otherwise have got them, its overall effect is less clear-cut. A study published in the British Journal of Cancer earlier this year2 found that English patients were as much as seven times more likely to be prescribed drugs rejected by NICE than patients in Wales, which is not covered by the fund. But three new drugs that NICE approved (pazopanib, bendamustine, and abiraterone) were adopted more slowly in England than in Wales. The existence of the fund, the authors concluded, did not speed up access to cost effective drugs.
Cite this as: BMJ 2014;349:g5382
↵Wise J. Charities welcome £50m interim cancer drugs fund. BMJ2010;341:c5464.FREE Full Text
↵Chamberlain C, Collin SM, Stephens P, Donovan J, Bahl A, Hollingworth W, Does the cancer drugs fund lead to faster uptake of cost effective drugs? A time trend analysis comparing England and Wales. Brit J Cancer2014; published online 25 Feb. doi:10.1038/bjc.2014.86.