Cancer Drugs Fund: spending unsustainable, and England still lags on new drug uptake

A new report into England’s controversial and problematic Cancer Drug Fund has been published today by the National Audit Office (NAO).

The NAO is the independent watchdog which monitors value for money in public spending, and has probed the broad effectiveness of the Fund.

While it deliberately stops short of suggesting answers to the many problems surrounding the CDF, it has brought those problems into sharper focus.

It re-emphasised widespread concerns about the Fund being ‘unsustainable’: its continued budget overspend, worries about the fairness and robustness of its decision-making, and its impact on wider national health service (NHS) priorities.

The investigation also highlighted a surprising fact: despite this special fund being created, England’s cancer patients still lag behind those in other countries in access to the newest drugs (those launched in the last five years) in the 2009-2013 period.

The report also found that use of cancer drugs launched 6-10 years ago have decreased in the UK relative to the international average; use of cancer drugs more than 10 years old increased to above the international average.

Moves are already underway for a major overhaul of the CDF, but initial reaction to the report suggest it has strengthened the calls for fundamental changes from the NHS, charities and the pharma industry.

NHS England is proposing changes which would make the CDF a ‘managed access fund’ by April 2016 and returning to NICE greater control of drug reimbursement.  However NHS England will undoubtedly want to retain influence in order to control costs. Despite the latest controversial de-listing of drugs, the Fund is still on track to overshoot its 2015-2016 budget of £410 million by £70 million.

Pharma industry response

Dr Richard Torbett, executive director, Commercial at the Association of the British Pharmaceutical Association (ABPI), said the report shed light on CDF’s impact and sustainability.

“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.”

The ABPI has long voiced its opinion that the CDF is not sustainable, but said a wider-scale reform was needed.

“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,” Torbett added.

The ABPI is pinning its hopes on the Accelerate Access Review (AAR) to deliver a more ‘joined-up’ system. The AAR, championed by Life Sciences minister George Freeman, aims to create a ‘lit runway’ for innovation in the UK, and is due to report by the end of 2015. However the report is likely to face obstacles because of the budget crisis in the NHS, with little or no prospect of extra funds for new medicines.

Patient outcomes and data collection problems

Probably the most important question raised by the NAO was this: what impact has the Fund had on patient outcomes?

The answer was simple: we don’t know. That’s because the real world data collection system intended to underpin the CDF since 2012 is still not in place.

The NAO says by the end of March 2015, all hospital trusts providing chemotherapy treatment were reporting data to the national chemotherapy dataset. However this dataset has not been able to distinguish between CDF funded care and ordinary NHS care or clinical trials. In July, NHS England and Public Health England established a data-sharing agreement, which should finally enable treatment and outcomes of patients on the CDF to be tracked.

Related links

Read the full NAO investigation here

Major overhaul of Cancer Drugs Fund proposed

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