What next for the Cancer Drugs Fund?

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The Cancer Drugs Fund is never far away from the headlines, and recent weeks have been no exception.

The Fund is a £280 million-a-year pot, set up in 2010 by the Government to pay for patients in England to receive cancer drugs that haven’t been approved by the National Institute for Health and Care Excellence (NICE).

Today, NHS England announced a number of big changes to the way the Cancer Drugs Fund will work in future, including more consideration of the costs of the drugs on the list, and a few that might eventually come off it (more on this below).

Meanwhile, last Wednesday Welsh cancer patients handed their Government a petition of nearly 100,000 signatures, just before a debate took place in the National Assembly on the potential to establish a Cancer Treatments Fund for Wales. This follows a similar campaign in Northern Ireland as well as changes that have taken place to the way Scotland assesses new drugs.

You would be forgiven for wondering what on earth is going on. And with the pace of recent changes, we are certainly concerned that not much thought has been given to communicating what they might mean to the public and patients.

So with this latest round of developments, we thought we’d take stock of the current situation, and what might happen next.

Changes to the Cancer Drugs Fund in England

Back in August the Government announced that, due to increasing demand for newer cancer drugs, it would inject an extra £80 million per year into the Fund, increasing it to £280 million per year. It pays for drugs for around 2,000 new patients each month.

But given the current pressures on NHS finances, the Government and NHS England recognised that they would have to find a way to manage financial pressure on the Fund.

So, in October, they put forward three major proposals for consultation:

• A new re-evaluation process would compare the clinical benefit of the drugs on the list, and potentially remove those with the lowest clinical benefit.
• The cost-effectiveness of drugs, i.e. their benefit weighed up against how much they cost, would now be considered. Currently drugs paid for by the Fund are only assessed for clinical benefit.
• Pharmaceutical companies will be able to make confidential cuts to how much their drug will cost the NHS in England, if they want the drugs to remain on the list.

So what did we make of all this? In our response to these ideas, we said we had some major concerns:

• Although thousands of patients have received drugs via the Fund, there is no publicly-available analysis of whether they actually benefited from them – and we can’t get access to that data. A proper evaluation is crucial so that evidence generated from the Fund can benefit all patients, both current and future.
• The Fund is becoming financially unsustainable, and this could ultimately detract from other important NHS services including those for other cancer treatments (for instance radiotherapy). So we can understand why CDF decision-makers want to take cost-effectiveness into account now, even though is still does not make sense as a long term solution: NICE already does this.

So we want to see:

• NHS England set up a robust mechanism for collecting data from patients treated via the Fund, so we can understand how CDF-listed drugs are benefiting patients.
• NHS England carry out a rapid evaluation of how the Fund has benefitted patients since it was initially set up.
• The Government, NHS England, NICE and others to go back to the drawing board and develop a long-term framework for funding evidence-based medicines. This would create a major role for NICE, and given that recent ‘value-based assessment’ proposals were ultimately stalled after much discussion, time is of the essence. But this will also involve the Government looking at how much the NHS is willing to pay for certain types of treatments, and for NHS England to consider how flexible it will be after NICE says no (currently, the Individual Funding Request route for “exceptional cases” is very restrictive).
• Consideration given to the idea that, in the longer-term, NHS England could give ‘conditional’ funding to some drugs used in small populations and/or for rare cancers, where it is harder to collect evidence of patient benefit. This funding would then continue after an evaluation to see if the drugs work well in these patients.
• The funding system in general to be more flexible to meet the individual needs of patients. Currently, the system of Individual Funding Requests (which doctors can apply for on behalf of patients in “exceptional” circumstances) is very restrictive. So while the Cancer Drugs Fund regularly pays for drugs for reasonably common conditions, it is often difficult to get drugs for patients in difficult or unusual circumstances. We would like to see a system put in place which does more for patients with difficult to treat conditions.

You can read our full response here.

Today, NHS England announced that – based on the responses to the consultation – it will take forward the original proposals as planned. We still don’t know much about what will happen in the long term, though we do know that there is already a list of drugs that will be considered for potential de-listing in December.

We hope that NHS England will clearly communicate any decisions made so that patients and doctors can understand their impact.

What is clear is that NHS England have said patients who are currently taking drugs on the CDF list will be able to continue taking them for as long as their doctor thinks is appropriate.

UK-wide inequality?

Availability of drugs varies around the UK

So that’s the situation in England.

But when you look at the way things work around the wider UK, things get even more confusing. As we said above, there’s growing pressure for similar systems in Wales and Northern Ireland.

Before we go further, it is important to note that there’s no way to compare what drugs cancer patients are getting in each UK nation, nor why they get them – so we have no idea how many patients outside England are getting Fund-listed drugs through other routes.

But it is fair to say the Cancer Drugs Fund in England has made it much more straightforward to get certain drugs, and some patients – though no-one knows how many – have actually moved to England to get drugs that may benefit them.

But would having a Cancer Drugs Fund in the other UK nations be helpful? We don’t think so – it is not a long-term solution. There is no evidence on how well it is working, it is financially unsustainable, and by creating a separate fund it bypasses the normal NHS decision-making and funding processes.

In Wales, the Health Minister Mark Drakeford continues to reject calls for a Welsh CDF, saying that it is “clinically contentious” and not based on good evidence. In the meantime, following a lengthy review of the Individual Patient Funding Request process (the route in Wales where funding for drugs can be given in “exceptional circumstances”), the Welsh Government has committed to changes which would likely make it more consistent.

This seems sensible, although few details are available, including timescales for the changes. We would also like to see the Welsh Government consider making its “exceptional circumstances” system more flexible.

So what’s next for the Cancer Drugs Fund?

Today’s announcement from NHS England sets out how the Fund will work for the foreseeable future (it is due to end in March 2016). We don’t think there will be any other major changes until after the 2015 General Election.

But we do hope this discussion will push the Government, NICE, NHS England and others into starting to develop and share ideas for what is needed in the long term – ready for the new Parliament to take these forward. We hope that any future changes will involve full consultation with patients and the public.

But this cannot, must not, take another 5 years.

And it’s not just about cancer drugs – there are plenty of other things we want all political parties to support to help more patients survive cancer in future.

In the meantime, we’d be interested to hear your views on the Cancer Drugs Fund in the comments section below.

Zoe Molyneux is a senior policy advisor at Cancer Research UK

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Money image by George Hodan [CC0], via Wikimedia Commons