More Cancer Drugs Fund cuts will be needed, warns chairman

The chairman of England's Cancer Drugs Fund says more drugs will have to be 'de-listed' in the future because of rising demand and rising drug costs.

Professor Peter Clark was speaking at a meeting in London just a few days after the Cancer Drugs Fund announced the de-listing of 15 different drugs across 25 different indications, including drugs for breast cancer, ovarian cancer, prostate and cervical cancer.

Funding has been cut to the drugs, which include Roche's Avastin and Novartis' Afinitor, because NHS England is facing a major overspend in its budget, with the Cancer Drugs Fund representing one of the biggest pressures.

The CDF budget is set at £280 million in the 2014/15 financial year ending in March. But even with the £80 million worth of cuts announced this week, the Fund's budget will still rise to £340 million next financial year in order to accommodate increased costs.

Peter Clark says demand for treatment through the CDF has been rising rapidly since 2013/14 – with spending also pushed up by the arrival of new high cost drugs.

Addressing the Westminster Health Forum meeting on the future of NICE and the pharmaceutical industry, Professor Clark said his main aim for 2015 was to address the disconnects in England's system, whereby NICE, NHS England and the CDF did not work seamlessly together.

He said until a more rational system could be agreed – and therefore allow better use of resources - further de-listing would be necessary.

"I suspect that until we have everything into the kind of process that I've outlined, yes, there will be further need for re-prioritisation of what sits in the Cancer Drugs Fund."

This will dismay charities and patient advocacy groups, particularly in those cancer types where de-listing could mean far fewer options available to patients. An example from this first de-listing was in colorectal cancer, where five indications were cut.

Speaking very frankly, Clark also said that one of the downsides of the CDF so far was that it had allowed pharma companies to charge higher prices. He said it had provided some companies with a 'Get Out of Jail card' for when NICE said no, adding: "They don't have to engage as constructively as they do in a NICE appraisal."

He said he was determined to fix some of the problems in the system. He said a far better system could be arrived at "by joining up what we (the CDF) are good at, with what NICE are good at - and of course with co-operation with the pharmaceutical industry."

Whilst sounding this collaborative note, Clark said very high prices set by pharma companies for new cancer drugs were a major issue, and not in keeping with the austerity measures the UK and the NHS were still dealing with.

"The pricing of some cancr drugs is not related to what we're all experiencing," he said.

Real world evidence

Part of Professor Clark's plan is to collect data on patient outcomes via the CDF, allowing the health service to see what impact the extra funding for drugs is having on extending lives.

This promises to be a huge step forward in measuring the value of medicines to patients – but is proving more difficult than anticipated.

The plan is to be achieved by auditing data from CDF applications, and linking it up with the Systemic Anti-Cancer Therapy Dataset (SACT), a new data-crunching team in Oxford.

However Professor Clark says that this data analysis is not yet fully operational, because of problems collecting good quality data from across the NHS.

"Some parts of the country give us fantastic data, while in other parts of the country it is very patchy," said Professor Clark.

"The commissioning arrangements that we are going to put in place in this next financial year will make the collection of this data much more robust. We need that for all of our treatment areas in the NHS – we clearly need it set up and working well for a process like this to proceed."

Also speaking at the event was NICE's deputy chief executive Gillian Leng, who said her organisation was also keen to resolve disconnects in the system and replications of processes.

One opportunity for creating a joined-up solution to medicines appraisals and market access could come with the Innovative Medicines and Medtech review, which was announced in November. The review led by Life Sciences Minister George Freeman is expected to announce its terms of reference shortly.