Cancer Drugs Fund would be reformed under Labour

Access to drugs and other cancer treatments could be a significant issue in next year's General Election in the UK, as the Labour party is seeking to take the high ground on providing the best treatment for cancer.

Yesterday the opposition Labour party declared it would replace the existing Cancer Drugs Fund (CDF) with a broader Cancer Treatment Fund, which would cover radiotherapy and surgery in addition to drugs.

The CDF was introduced in England by the Conservative / Lib Dem coalition government in 2011, and has allowed access to drugs either rejected by cost-effectiveness body NICE, or not yet reviewed.

However, the CDF has proven controversial, as its annual budget has risen steadily, from £50 million a year to £280 million from next year.

Among the criticisms of the CDF is that it values cancer drugs above other cancer treatments, namely radiotherapy and surgery, and Labour says a fund covering all these treatments will be better for patients, and more evidence-based.

The current government has pledged to maintain the CDF until at least April 2016, even though many say it should be scrapped, and the existing 'mainstream' NICE process reformed to ensure more reliable access to new cancer treatments. Many health commentators say the CDF is unfair for patients with all other conditions, who don't have their own dedicated funds.

Labour have stopped short of scrapping the fund, as this would not have played well politically, especially in the influential Daily Mail newspaper, which made cancer drugs access a major issue before 2011. Instead Labour has sought a compromise solution, retaining the current CDF until April 2016, after which time the new broader fund would be introduced.

The fund would have a £330 billion budget for all treatments – only £50 million more than the existing plans for the CDF, which suggests funding could be tighter for drugs once this sum is split three ways.

The announcement was made at the Britain Against Cancer conference in London, and was part of an unveiling of Labour's broader cancer strategy.

Andy Burnham said: "My goal is to make the NHS the best health service in the world for the treatment of cancer. We will only achieve that if we give patients access to the most effective forms of treatment, including advanced radiotherapy."

"The problem with cancer policy under the current Government is that it prioritises one form of cancer treatment over others and places one group of patients ahead of another. This is indefensible when we know surgery and radiotherapy are responsible for nine in ten cases where cancer is cured. It is not right that 40,000 people every year who could benefit from radiotherapy are missing out.

"This is why Labour will build on the benefits of the Cancer Drugs Fund but extend the principles of improving access and supporting innovation to all forms of cancer treatment and all cancer patients."

At the same conference, Conservative health secretary Jeremy Hunt said his party would 'continue to champion' the CDF – but added that it needed to be 'sustainable and scientifically credible'.

This last remark acknowledged widespread concerns that the CDF has been paying too high prices for drugs approved through this route, and that its clinical and cost effectiveness scrutiny is not as robust as NICE's appraisal system.

The CDF is currently being reviewed, with a number of companies expecting their drugs to be de-listed from the approved list in early 2015, with a more strict approach now judging them not sufficiently cost or clinically effective. Drugs which have already been named as at risk of being de-listed include Roche's breast cancer drug Perjeta, Avastin (numerous cancers) and Novartis' breast cancer drug Afinitor. The de-listing process will be discussed at a crucial meeting of the CDF this Monday – the full list of drugs to be reviewed is here.

Hunt told the Britain Against Cancer conference that room needed to be made within the CDF for new drugs, and that it needed to live within its budget – a reference to its continued expansion beyond its agreed limits since 2011.

Talking to pharmaphorum at the conference, representatives from charities and pharmaceutical companies expressed their concerns about the CDF de-listing process, and said some patients who could benefit from drugs could miss out if the review wasn't handled properly.

Responding to Labour's announcement Stephen Whitehead, chief executive of the UK's pharma organisation the ABPI said:

"The ABPI welcomes the Shadow Secretary of State's recognition of the poor availability of new and exciting medicines for patients in the UK. Cancer medicines in particular lagged behind and the CDF was introduced to enable patients to have access to cancer medicines that are routinely available in other EU countries.

The fund has gone some of the way to address this although the UK still lags behind Germany, France and Italy as regards the access to medicines for patients in need. This is despite the fact that the price of branded medicines in the UK is still amongst the lowest in Europe.

Whitehead said the ABPI believed the best way to improve the system and improve access to medicines would be to reform NICE. He said the cost-effectiveness body needs to be able to look at new medicines with "greater flexibility whilst also balancing the affordability issue." He added: "The long term sustainable solution is of course to utilise the expertise of NICE in partnership with NHS England to address this challenge."

The government agreed a new pricing agreement, the Pharmaceutical Pricing Regulation Scheme (PPRS) in January 2014, which guarantees the NHS will pay a fixed amount for its medicines, regardless of the amount it uses. The deal was seen as a good one for both pharma and the NHS – however the health service has continued to be as price-sensitive as ever, to the frustration of industry.