The Cancer Drugs Fund
Cancer treatment has developed substantially in recent years, leading to improved outcomes and quality of life of life for patients. However, it has also led to increased cost and capacity pressures for the NHS. There is evidence to suggest that the UK lags behind the rest of Europe for access to new cancer drugs.1
The National Institute for Health and Clinical Excellence is an independent body that, among other functions, provides guidance for the NHS on new and existing medicines, treatments and procedures. The NHS budget is limited. Independent advice provided by NICE is intended to ensure that the most effective, safe and cost-effective treatments are prioritised to give value for money for the NHS.
However this has meant that some more expensive treatments (including expensive cancer drugs 2) that do not meet the thresholds for value for money have not been approved for general use. A number of high profile, independent studies have described the technical expertise and role of NICE in conducting cost-effectiveness assessments as world class. 3
Historically, treatments (including treatments for cancer) which have not been approved by NICE for standard use in the NHS have been subject to local individual funding review panels approval, which, for a small number of individuals, has led to a variation in access to drugs between different areas of the country.4 There have been some high profile cases of individuals who were unable to access the cancer drugs or treatment that they wanted because it had not met NICE criteria and it had not been approved by a local individual funding review panel.2
The Department of Health has announced that it is working towards a Value-based Pricing (VbP) system for all drugs, to replace the Pharmaceutical Price Regulation Scheme when it expires in 2014.5 In the interim, a Cancer Drugs Fund of £200 million a year is proposed to cover cancer treatments that are not currently available on the NHS. The Cancer Drugs Fund is intended to consider treatments:
- not yet appraised by NICE
- considered too rare for appraisal
- not recommended by NICE on grounds of cost-effectiveness or
- not licensed for the proposed clinical purpose
NICE will still provide guidance on the funding of treatments but, in the future, decisions to fund specific treatments will be taken locally by GPs.
Evidence of the possible benefits
There is evidence to suggest that there is considerable unmet need in the treatment of cancer patients, which the revised funding system aims to address.1, 2, 4, 5, PCTs receive 15,000 exceptional funding requests each year, of which a quarter are for cancer drugs.4 A cancer charity has estimated that the Cancer Drugs Fund could benefit over 10,000 patients per year.2
The Office of Fair Trading’s review of the Pharmaceutical Price Regulation Scheme found that the existing controls did not take account of the therapeutic value of drugs, and identified a number of drugs where prices were significantly out of line with patient benefit. However, this study did not consider cancer drugs explicitly.3
It has been recommended that the Cancer Drugs Fund, while in existence, is used as a pilot to determine its value for money. This pilot will in turn inform the Value Based Funding approach when it is implemented.2,5 However, £50 million was invested in additional cancer drugs in 2010/11, which has not been evaluated before further investment.
Evidence of the possible risks
The Cancer Drugs Fund will be provided via GPs and local providers. Whilst they may take advice and guidance from NICE into account in these decisions, geographic variation in the administration of this fund will be an inevitable consequence, as has been seen in the past.4, 6 In addition, the shift in decision making powers to the GPs will put them under significant pressure in balancing population budgets with individual patient demands.
The Fund is to be funded from existing primary care trust budgets. There has not been an assessment of the relative impact of the £200million annual fund if it were spent on health priorities other than cancer drugs. The government’s cancer tsar Sir Mike Richards has repeatedly pointed out that early detection, radiotherapy and surgery are often a much better investment than many of the new cancer drugs that come on the market.7
Any implications for health & well-being
The policy of implementing an additional fund to cover cancer drugs that are not currently available on the NHS is likely to be of benefit to cancer patients, but there is insufficient evidence available currently to quantify the extent of this benefit. The Cancer Drugs Fund itself will serve as an evidence base for future price systems.
The effectiveness of this expenditure on cancer drugs, compared to alternative evidence-based cost-effective uses of the allocated money, has not been evaluated. It is likely that there will be variation in the way in which this fund is administered across the country.
Authors:
Amy Potter MSc, Specialty Registrar Public Health, London Deanery & Abigail Knight MSc, Senior Public Health Strategist, NHS Tower Hamlets
UK area affected: England only
1. Wilking, N. and Jonsson, B. (2005) A pan-European comparison regarding patient access to cancer drugs. Karolinska Institute and Stockholm School of Economics, Sweden. http://ki.se/content/1/c4/33/52/Cancer_Report.pdf
2. Rarer Cancers Foundation, (2010) Exceptional Funding: recommendations for improving access to cancer medicines and delivering better value for money for the NHS. http://www.rarercancers.org.uk/news/current/ exceptional%20funding%20-%20final.pdf
3. OFT (2007) The Pharmaceutical Price Regulation Scheme. http://www.oft.gov.uk/shared_oft/reports/comp_policy/oft885.pdf
4. Richards, M. (2008). Improving access to medicines for NHS patients. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_089952.pdf
5. DH (2011) Improving Outcomes – A Strategy for Cancer. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123394.pdf
6. DH, (2011).The Cancer Drugs Fund. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_125449.pdf
7. Edwards, N. (2011) Nasty side-effects anticipated. Health Service Journal.
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