Cancer drugs fund cuts £80 million through de-listing and price talks
England's Cancer Drugs Fund has confirmed that a number of cancer treatments will no longer be funded, helping it to cut an estimated £80 million from its growing budget.
Among these drugs is Roche's Avastin (bevacizumab), which will now be de-listed in two uses in advanced colorectal cancer and one in advanced ovarian cancer. Sanofi will see both of its CDF drugs de-listed, Zaltrap (aflibercept) for metastatic colorectal cancer and Jevtana (cabazitaxel) for metastatic prostate cancer, while in advanced breast cancer, Novartis' Afinitor (everolimus) and Eisai's Halaven (eribulin) will also no longer be funded.
However behind-the-scenes negotiation between England's Department of Health and pharma companies on prices has allowed numerous drugs to stay on the list. Most notable among these are Roche's new breast cancer drugs, Perjeta and Kadcyla.
The result of the review is that 59 of the 84 most effective currently approved indications (clinical 'uses') of drugs will be retained on the CDF. The government says that this will create headroom for new drug indications that will be funded for the first time. These are Amgen's bowel cancer drug Vectibix (panitumumab) and two uses of Janssen's Imbruvica (ibrutinib) - in Mantle cell lymphoma, a type of non-Hodgkin lymphoma and for use in chronic lymphocytic leukaemia (CLL).
Following these changes, the CDF says it is putting in place four important patient protections:
• Any patient currently receiving a drug through the CDF will continue to receive it, regardless of whether it remains in the CDF.
• Drugs which are the only therapy for the cancer in question will remain available through the CDF.
• If the CDF panel removes a drug for a particular indication, some patients may instead be able to receive it in another line of therapy or receive an alternative CDF approved drug.
• Clinicians can apply for their patient to receive a drug not available through the CDF on an exceptional basis.
Professor Peter Clark, Chair of the Cancer Drugs Fund (CDF) and a practising oncologist, said: "We have been through a robust, evidence-based process to ensure the drugs available offer the best clinical benefit, getting the most for patients from every pound.
"There were drugs that did not offer sufficient clinical benefit so we simply cannot go on funding those. There were others that offered some benefit but were costly and I am pleased that a number of pharmaceutical firms worked with us to make prices more affordable, saving millions of pounds that can now be reinvested in other treatments.
"These are difficult decisions, but if we don't prioritise the drugs that offer the best value, many people could miss out on promising, more effective treatments that are in the pipeline."
Dr Jayson Dallas, General Manager of Roche in the UK commented: "We are pleased that we have been able to work collaboratively with NHS England to maintain access via the CDF to our highly innovative and clinically effective medicines for breast cancer, Perjeta and Kadcyla, at prices that reflect their clinical benefit.
Dr Dallas added: "The review demonstrates that industry and NHS England can work together to make sure the very latest medicines are available to patients." Patients will still be able to access Avastin for a number of cancers but we are disappointed that, for the time being, the value of Avastin to advanced bowel and ovarian cancer patients has not been recognised; we do not agree with NHS England's assessment and feel that critical evidence was not taken into account."
The CDF is likely to generate further controversy, however. Funding for the NHS is set to be a major issue for the forthcoming UK general election in May, and Labour are proposing changes to the CDF which would broaden it to include radiotherapy and surgery.
The UK industry body the ABPI has also made it clear that it believes that the central NICE process should be reformed, rather than retaining a separate fund for cancer.
Despite the cuts, the CDF's budget will grow from £200 million in 2013/14, to £280 million in 2014/15, and an estimated £340 million from April 2015. This represents a total increase of 70 per cent since August 2014. This will also be a source of controversy, as austerity measures across the NHS are bringing services to breaking point.
Read the full CDF press release, and view the newly updated list here
More analysis and reaction to follow
