The UK’s National Audit Office (NAO) has put an official seal on what has been generally known – the Cancer Drugs Fund (CDF) cannot continue in its current form and a new scheme is urgently needed.
The CDF was originally intended as a stop-gap while a new pricing mechanism for drugs was developed, but had to be extended when the government’s attempts to replace the Pharmaceutical Price Regulation Scheme (PPRS) with a new value-based pricing model stalled.
There is no doubt that the CDF has improved patient access to cancer medicines, but with the total spend already around the £1bn mark since it was formed in 2010 – and starting to impact on funding available for other health services – an alternative must be found, says the NAO in its report.
As of March 2015, the total cost of the CDF was £968m, with just over 74,000 patients approved to receive drugs through the fund, and the overspend for 2014-15 was 48%.
NHS England has already set the wheels in motion to trim back costs, culling 15 medicines at the start of the year (one was re-instated on appeal) and proposing to cut another 16 drugs earlier this month.
The restrictions have been attacked by the drug industry and patient organisations, which have argued that patients would die as a result and the fund should have been left to run while an alternative system was developed.
Financial considerations aside, the CDF also has considerable gaps in its data that make it impossible at present to gauge its impact on patient outcomes, which the NAO notes is a major failing of the programme under the management of the NHS and Department of Health.
Public Accounts Committee chair Meg Hillier said it “makes no sense that the department and NHS England lack the data needed to assess the effectiveness of the CDF and whether it is the best way to care for patients”.
NICE’s gatekeeper role restored?
“All parties agree that the fund is not sustainable in its current form,” says the report, which notes that in July NHS England proposed that the fund should become a managed access programme.
Under those plans, the fund would pay for new drugs on a temporary basis before the National Institute for Health and Care Excellence (NICE) decides whether they should be recommended for routine prescribing.
If rejected by NICE, they would no longer be supported. That is a significant departure from the CDF’s original ethos, given that between 2013 and 2015, 51% of patients received drugs that the agency had assessed but not recommended for routine use.
The NAO acknowledges those proposals but does not comment on them, noting that a public consultation is due to start in the autumn with a view to implementing a new scheme from April 2016.
The Association of the British Pharmaceutical Industry (ABPI) welcomed the publication of the report, and agreed with its conclusion that the CDF is not sustainable.
The trade body highlighted that “the use of new cancer drugs in the UK still remains below the average in other comparable countries”, and suggested a reform of the CDF is not enough.
“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,” said the ABPI’s executive director Dr Richard Torbett.