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The NHS Cancer Drugs Fund (CDF) has not provided meaningful value to cancer patients and wider society and may have unnecessarily exposed patients to adverse drug reactions, according to a study published in the Annals of Oncology.
The researchers focused on 29 cancer drugs approved for 47 indications that could be prescribed through the CDF in January 2015. They analysed the potential value delivered by the CDF according to six value criteria: evidence of drug efficacy; effectiveness in ‘real world’ populations; value according to the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO); cost effectiveness according to the National Institute for Health and Care Excellence (NICE) thresholds; CDF’s own audit; and value delivered to NHS patients.
Of the 47 indications: only 38% reported a statistically significant overall survival benefit; 48% and 18% met ASCO and ESMO criteria, respectively; 55% of the indications had been rejected by NICE because they did not meet its cost-effectiveness thresholds; and 13 were delisted in 2015 due to insufficient evidence for clinical benefit.
The researchers concluded that there was no evidence to support a “drug only” ring-fenced cancer fund and that decisions for all drugs and interventions should be made through appropriate health technology appraisal processes.
“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” says Richard Sullivan, director of the Institute of Cancer Policy at King’s College London and co-author of the study.
The CDF was originally established in 2010 to improve access to cancer drugs not available through the NHS due to not being appraised, being in the process of being appraised or already appraised but not recommended by NICE.
After £1.27bn expenditure and following a three-month parliamentary review, the CDF was rationalised back into NICE in 2016.
