Cancer drugs fund

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Specific to NHS England. Revamped 2016 with change of government. A large waste of public money[1].

QuotationMarkLeft.png was being used by the drug industry as a "get out of jail" card for drugs that would not be approved by NICE and -in the case of 25 out of the 85 currently on the fund's list- that had not even been submitted for appraisal QuotationMarkRight.pngDr. Peter Clark, Chair Cancer Drugs Fund, BMJ 2015:350:h270

It was a poor political decision, there was no basic outcome monitoring by the funders or by many clinicians and clearly many clinicians who accessed funded drugs did not do so, based on the evidence base for effectiveness in specific indications, available at the time of access.

In 2010 as a result of political lobbying the UK government created the Cancer Drugs Fund (CDF) as a separate funded resource with a different commissioning policy prioritisation to the processes that then existed in the English NHS medicines management for high cost drugs. Some believed from the beginning, that despite its public popularity the CDF lacked coherence and failed to support evidence-based decision making[2]. Indeed this was likely, as effectively the CDF was created to respect the principle of providing treatments to patients that they themselves value, making health policy closer to treating the patient, not the disease[3]. When faced with a scenario of short expected survival, most prefer treatments that provide a modest chance of a significant survival gain, even if these reduce average survival[4]. Prior to this, new high cost drugs for an indication were prioritised mainly according to a NICE appraisal process, which although objective against predefined criteria, was often not timely. NICE used criteria that discriminated against relative health gain as opposed to absolute health gain. Some local commissioning occurred to speed access. However if a drug indication was not prioritised by NICE in a technical appraisal, within 3 months all NHS commissioning in England for new patients ceased. With the creation of the fund, ten regional prioritisation groups could consider cancer therapies independent of NICE and create local prioritisation within the annual budget. NHS Wales adopted a different system, which respected NICE technical appraisal decisions but allowed local commissioning in advance of any NICE decision. In due course analysis contrasting access in Wales (which respects NICE determinations) and England concluded that in England the CDF was used to access drugs deemed not cost-effective by NICE and it did not expedite access to new cost-effective cancer agents prior to NICE approval[5]. In April 2013 the newly created NHS England took over fully the Cancer Drug Fund. As the ten local groups had developed different prioritisation with regional variation illustrated by twice the number of applications per head of population in the south of England compared to the north, a major initial commissioning priority was removal of this regional variation[6]. Even so the inbuilt distortions quickly lead to fund blow out. Complicating matters was a new pharmaceutical price regulation scheme which as of 2014, because of the existence of the Cancer Drugs Fund, is expected to penalise manufacturers who have more high cost non-cancer drugs in their portfolio. By 2014 there was considerable evidence that relatively ineffective therapies were being funded and that patients with non-cancer diagnoses where a novel high cost drug entered the market were being disadvantaged relative to cancer patients[7]. According the fund settlement and process of prioritisation was reformed, notably with a 2 year settlement that will allow further political decisions after the next UK election[8]

References

  1. Aggarwal A, Fojo T, Chamberlain C, Davis C, Sullivan R. Do patient access schemes for high-cost cancer drugs deliver value to society?—lessons from the NHS Cancer Drugs Fund. Annals of Oncology 2017DOI:https://doi.org/10.1093/annonc/mdx110
  2. New 50 million pound cancer fund already intellectually bankrupt. Lancet. 2010 Aug 7; 376(9739):389.(Link to article – subscription may be required.)
  3. Lakdawalla DN, Jena AB, Doctor JN. Careful use of science to advance the debate on the UK Cancer Drugs Fund. JAMA : the journal of the American Medical Association. 2014 Jan 1; 311(1):25-6.(Link to article – subscription may be required.)
  4. Verhoef LC, de Haan AF, van Daal WA. Risk attitude in gambles with years of life: empirical support for prospect theory. Medical decision making : an international journal of the Society for Medical Decision Making. 1994 Apr-Jun; 14(2):194-200.
  5. 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. British journal of cancer. 2014 Feb 25.(Epub ahead of print) (Link to article – subscription may be required.)
  6. Torjesen I. Number of patients eligible for fast track access to drugs through the cancer drugs fund is slashed. BMJ (Clinical research ed.). 2013; 346:f2197.(Epub)
  7. Jack A. Which way now for the Cancer Drugs Fund? BMJ (Clinical research ed.). 2014; 349:g5524.(Epub)
  8. Hawkes N. Cancer Drugs Fund receives boost but will no longer fund "overpriced" drugs. BMJ (Clinical research ed.). 2014; 349:g5382.(Epub)