Cancer Drugs Fund in England 'Needs Urgent Reform'

Liam Davenport

February 08, 2016

The Cancer Drugs Fund (CDF) in England has not been managed effectively and needs urgent reform to stop costs from spiraling out of control and to ensure that it is improving patient outcomes, warns a spending watchdog.

The CDF was set up in 2010 by the previous government to provide access to cancer drugs not approved by the health watchdog, the National Institute for Health and Care Excellence. These drugs would otherwise only be available in England to people who could pay for them privately.

Although the CDF is credited with having provided access to otherwise out-of-reach drugs to around 80,000 cancer patients, it has courted controversy since its launch. As previously reported by Medscape Medical News, there have been numerous cost overruns and experts have questioned its ethical basis.

The future of the CDF is now under discussion. A public consultation on a number of proposed structural reforms to the CDF is due to close on February 11.

In the meantime, a report published on February 5 by the House of Commons Committee of Public Accounts makes a series of damning observations about the CDF.

Meg Hillier MP, chair of the Public Accounts Committee, said in a release: "The Cancer Drugs Fund has enabled thousands of people to receive drugs not normally available to them through the NHS. While this is welcome, it's also clear the Fund requires significant and urgent reform if it is to be sustainable."

She added: "A vital step in addressing the financial challenges must be to properly evaluate the health benefits of drugs provided through the Fund."

"If cancer patients seeking its support are to get the best possible treatment then there must be confidence that public money is being spent on the right medication, and at a fair price."

In the report, the Committee said that it is "unacceptable" that the government remains unable to assess the benefits to patients from the scheme, even though it has now been in place for 6 years. It found that neither the Department of Health nor NHS England have the necessary data to be able to assess the impact of the CDF on patient outcomes, such as increasing survival, or to demonstrate whether the Fund represents "a good use of taxpayers' money."

The Committee also asserts that the CDF has not been managed effectively, noting that it overspent by £167 million in the past 2 years (2013 to 2015), despite the budget having been increased by 138% in 2013 (the budget went from £175 million in 2012/13 to £416 million in 2014/15). And in spite of further increases, the CDF still expects to overspend by £70 to £90 million in 2015/16, it points out.

Another area of controversy has been the prices that the CDF has been paying for drugs. While the report praises NHS England for securing discounts from pharmaceutical companies after threatening to stop providing access to some drugs to control costs, it highlights shortcomings in its ability to negotiate.

It's been crumbling under demand.

For example, Roche told the Committee that it offered a package of savings to NHS England for a number of medicines that would have resulted in discounts of £15 million. However, the Department of Health's pricing policy did not allow NHS England to discuss such a deal.

In a reaction to the report, Andrew Wilson, chief executive of the Rarer Cancers Foundation, told the Daily Mail: "It is alarming that NHS England has been leaving deals on the table which could have saved money."

He continued: "The CDF needs to pass two tests: Does it make available drugs and does it get the best price? The NHS is failing on both counts."

In the same article, Mark Flannagan, chief executive of the charity Beating Bowel Cancer, observed: "The creation of the Cancer Drugs Fund has been a huge step forward, meaning increased survival and quality of life for thousands of patients, but it's been crumbling under demand."


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