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Cancer Drugs Fund faces renewed barrage of criticism

Comments come ahead of next week’s NHS England review of the Fund’s assessment priorities

Caroline White

Friday, 09 January 2015

The controversial Cancer Drugs Fund (CDF) is facing a renewed barrage of criticism ahead of NHS England’s review of the Fund’s assessment process, the results of which are expected early next week.

In November last year, NHS England announced that it would be changing the way in which it assesses which drugs to make available on the Fund, to include their value for money to the NHS in terms of projected survival and quality of life.

NHS England has admitted that the Fund is overspent by more than £30 million for 2013-14, with some estimates putting the overspend as high as £100 million.

Using the new criteria, it re-evaluated 42 drugs in December, including six drugs currently available for breast cancer, six for bowel cancer, and six for lymphoma, and 12 new drugs.

It is widely expected that when it publishes the findings of that review next week, several high cost drugs will no longer be made available, although they will be available to patients already prescribed them.

The £200 million Fund was set up in 2010, to enable patients to access drugs they would not otherwise be able to do so on the NHS. And the government recently announced a further cash injection of £160 million over the next two years until the Fund ends in March 2016.

But the merits of the Fund have been hotly contested, and criticisms have been renewed following comments made by some of the drugs companies likely to be affected by the new assessment criteria earlier this week.

Former editor of The BMJ, Richard Smith, whose comments last week about the merits of a cancer death divided opinion, tweeted that the Fund’s resource would be much better diverted to dementia care.

Dr Charlotte Chamberlain, Clinical Research Fellow, School of Social and Community Medicine, University of Bristol, said: “The CDF has been seen as a ‘back door’ to funding high-cost cancer drugs on the NHS. Introducing negotiations with pharmaceutical companies over cost is overdue to prevent further unsustainable costs for the NHS.”

She added: “Unfettered access to cancer drugs, without thought to the opportunity cost of where else NHS money may be spent, such as on other proven cancer treatments, such as radiotherapy, is unfair. Robust assessment of the value cancer drugs bring to cancer survival and quality of life must be compared against the value of other cancer treatments – and treatments for other diseases.”

Dr Paul Catchpole, Director of Value and Access, at the Association of the British Pharmaceutical Industry, described the NHS England mechanism for evaluating medicines as “crude.”

He added: “There is a risk that by evaluating cancer medicines in this manner important costs and benefits will be missed out of the process, potentially resulting at best in misleading conclusions being drawn and at worst NHS patients being denied access to CDF medicines which do provide significant health benefit. We urgently need a clear plan with a set of agreed timelines setting out how a sustainable solution will be achieved.”

Dr Mangesh Thorat, Research Fellow, at the Centre for Cancer Prevention, Queen Mary University of London (QMUL), said: “As a cancer clinician, I am happy that this Cancer Drugs Fund prevents my patients from being denied treatments towards end of their life, however, on the other hand I think this fund not only undermines NICE but also discriminates against patients in similar situations who have diseases other than cancer.”

Prof Richard Sullivan, Director of Institute of Cancer Policy, said: “The Cancer Drugs Fund has been one of the most poorly thought through pieces of health public policy. There was almost no in-built oversight to actually ascertain whether those drugs on the CDF were actually leading to improvements in survival or quality of life, relative to the toxicity they caused.”

The money would have been much better spend on radiotherapy and surgery, the primary methods of cancer treatment, and which are known to work.

And Karl Claxton, Professor of Economics, University of York, said: "The evidence suggests that much greater improvements in health outcomes for NHS patients would have been possible across a range of diseases (including cancer) if the substantial resources of the CDF had been made available to the NHS. 

"There is no doubt that the CDF has done more harm than good for NHS patients, overall. The real beneficiaries of the CDF are manufacturers who have been able to sell their drugs to the NHS at prices that are unaffordable.”

In response to the criticisms, the Department of Health said: “The Cancer Drugs Fund has already helped over 60,000 people with cancer to get life-extending drugs that would not otherwise have been available to them. NHS England is currently working to ensure that the very latest, most clinically effective drugs can be made available to patients.”

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