A stinging critique of the Cancer Drugs Fund by cancer experts says that the majority of drugs it provided to patients failed to show any evidence of a benefit – and may have caused harm.
The analysis – led by academic clinical oncologist Dr Ajay Aggarwal of the London School of Hygiene & Tropical Medicine (UK) and Professor Richard Sullivan, director of the Institute of Cancer Policy, King’s College London – reviewed the operation of the CDF between 2010 and 2016.
Looking at 29 drugs approved for use in 47 indications under the CDF they conclude that only 38% were based on trials showing a benefit on overall survival, and that after taking into account factors such as quality of life and side effects “the majority of the drugs failed to show any evidence of meaningful clinical benefit”.
The researchers claim that a cull of the covered drugs that occurred in 2015 resulted in more than half (24) of the indications being removed, but that in 18 of these the evidence cited existed before the CDF was set up. That suggests “wastage of resources but equally that drugs were given that were ineffective and probably resulted in unnecessary toxicities for patients”, according to Aggarwal.
“The majority of cancer medicines funded through the CDF were found wanting with respect to what patients, clinicians and NICE would count as clinically meaningful benefit,” he added. The research is published in the journal Annals of Oncology.
Operation of the CDF – which came about as a result of a Conservative campaign pledge to fund cancer drugs not covered by the National Health Service – cost the taxpayer £1.27bn over that time, which Aggarwal pointed out was “the equivalent of one year’s total spend on all cancer drugs in the NHS”.
The CDF has now been replaced by a fund that is managed directly by the National Institute for Health and Care Excellence (NICE), after repeatedly running over budget and being beset by claims that it did more to help pharma companies than patients by giving less incentive for drugmakers to agree to affordable prices for their drugs.
Aggarwal and Sullivan also find it incomprehensible that no data on the outcome of patients who received treatment through the fund was collected.
“A ring-fenced drugs fund was created despite a lack of evidence that prioritising drug expenditure would improve outcomes for cancer patients over and above greater investment in the whole cancer management pathway, which includes screening, diagnostics, radiotherapy, surgery and palliative care,” said Sullivan.
“We recommend that other countries that are considering similar ring-fenced drug access funds for high cost cancer drugs should adopt a more rational approach to funding high cost health technologies.”
A spokesman for the Association of the British Pharmaceutical Industry (ABPI) told the Associated Press that there was not enough evidence to back up the claims made by the researchers, adding that many of the drugs covered by the fund have been or will be approved by NICE for routine NHS use.