England’s Cancer Drugs Fund: Will Patients Pay the Price for Being at the Back of the Line?

Leela Barham looks at the implications of another round of cuts due to England’s Cancer Drugs Fund in November.

Cancer is never far from the headlines, whether it’s what we should do more, or less of, to change our chances of getting the disease, the excitement from breakthroughs such as immunotherapy, or, it seems, England’s Cancer Drugs Fund (CDF).

The CDF was introduced all the way back in 2010. It’s turned out to be a relatively long running ‘temporary’ policy introduced to grab votes in the run up to the 2010 General Election as part of the Conservative Manifesto. Fast forward to September 2015 and headlines are no longer about the thousands of patients benefiting from new cancer therapies paid for by the fund. Instead they’re about the thousands who will now lose out as the number of drugs and indications are cut by NHS England: from 84 therapies at the beginning of 2015 to 41 by November this year.

The CDF has never been popular with everyone, even if it did generate benefits for thousands of cancer patients. For good reasons too with some big questions about the policy: why should cancer get priority? Could more health be generated by spending the money elsewhere? Does the CDF generate perverse incentives? Doesn’t it just undermine the National Institute for Health and Care Excellence (NICE)?

The current situation though can hardly please anyone; even those patients where their clinicians’ preferred treatment is covered might be a little worried about what will happen in the future. That’s because the continual change to the list – it was already changed in March this year - is generating the possibility that if you’re in the wrong place in the queue you just might miss out. That might sound sensationalist; I’m not aware of examples of real life patients who were about to be prescribed a drug that was covered but then delisted. However the principle that despite having the very same characteristics of a patient treated in September that a patient might miss out just a few months later in December because of a round of cuts to the fund feels very uncomfortable indeed in an NHS striving to tackle inequalities.

The fund is also doing little to help with some of the underlying reasons that not all new cancer drugs are available. For some new cancer medicines it is a question of price; of course what is a fair price is hotly debated and not covered here. In others though, it can be because of uncertainty in the clinical as well as cost effectiveness of a drug. A need for more evidence seems to be the case for drugs like bendamustine in mantle cell lymphoma and in chronic lymphatic leukaemia, bosutinib in accelerated phase chronic myeloid leukaemmia and chronic phase chronic myeloid leukaemia, and brentuximab in relapsed anaplastic large cell lymphoma - all of which are due to be delisted in November.

So far, despite the CDF including money for audit, and the presence of the Systematic Anti-Cancer Therapy (SACT) dataset, we don’t know if clinical uncertainties have been resolved. Maybe they can’t all be, but it would be reassuring to know what we’ve achieved with CDF money - expected to be over a £1bn by 2016. Not to mention whether that would change how these drugs are seen in terms of their real life clinical and cost effectiveness.

The fund is currently intended to last until March 2016. It looks like it will stay for longer though. NHSE have suggested it will become a ‘managed access fund’. A consultation is expected any moment on just what the ‘new’ CDF should look like from April 2016. So watch this space….

Leela Barham is an independent health economist and policy expert. You can access her website here and contact her at leels@btinternet.com