Reforming the Cancer Drugs Fund
Yesterday the NHS England Board met to approve plans for a new funding system for cancer drugs. The Board voted to approve these plans, which will come into effect on 1 July 2016. The current CDF will end on the 1 April 2016. We take a look at what has happened so far and outline our concerns on the new proposals.
The Cancer Drugs Fund
The Fund was set up in 2010 to pay for cancer drugs that the National Institute for Care and Clinical Excellence (NICE) had not approved for use on the NHS. Since then the Cancer Drugs Fund (CDF) has provided treatment to more than 10,000 people affected by bowel cancer. These are potentially life-extending treatments that patients with advanced bowel cancer would not have otherwise been able to access. However the CDF consistently over spent and recently NHS England began a delisting process in which cancer drugs were removed from the CDF based on clinical and cost-effectiveness. The CDF was always intended to be a short-term solution to a long-term problem and in 2015 NHS England published a consultation outlining a new system for the way cancer drugs are funded.
In short, under the new CDF proposals, NICE will assess all new cancer drugs. These drugs will receive one of three recommendations:
- Approval for use on the NHS
- Not approved for use on the NHS
- Conditional approval
The new ‘conditional approval’ recommendation would enable a drug to be used through the CDF for up to two years. During this time further evidence on the longer-term benefits, which may not be available at the time of licensing, is collected. At the end of this period, the drug would go through a short NICE appraisal based on the additional evidence. At this point, a positive recommendation would mean the drug can be used within the NHS, while a negative one would see it move out of the CDF and become available only on the basis of individual patient funding requests.
The NHS England Board agreed to delay the start of the new proposals until 1 July to allow them more time to work out the detail of the proposals. The current CDF arrangement will still come to an end on the 1 April. However patients will still have access to the drugs available on the CDF until the transition has completed.
A backward step for access to life-saving bowel cancer drugs
We agreed with the concept of a ‘managed access’ fund, however, the CDF was, in part, created in recognition that current NICE methodology is not fit to appraise cancer drugs and does not take into account the wider societal benefits that cancer drugs have. The proposals have not outlined any significant changes to the NICE process and without fundamental reform of NICE methodology we do not believe that the proposal will increase access to cancer drugs. In fact we believe that the proposals will actually decrease access to bowel cancer drugs.
A lack of detail
There is still a lot of uncertainty around the proposals and how they will work in practice that needs to be addressed urgently. The proposals outlined in the consultation document do not provide sufficient detail and many aspects of the consultation require clarification. For example, there is a lack of detail on how the managed access fun will operate and what the entry and exit criteria is for drugs placed in the CDF. We are also unclear on what type of data is needed for a drug to go on to receive a positive recommendation and how this data should be collected. In particular, there is no detail on how patient quality of life will feature as part of data collection or how this data will be captured.
Time is running out
We have huge concerns around the timescale for implementation of the new proposals. The consultation closed only two weeks ago and received nearly 300 responses. We do not believe that this has allowed NHS England and NICE sufficient time to address the many concerns raised in the responses. It is absolutely necessary that time is taken to address these concerns to ensure that proposals are fit for purpose and will increase access to innovative cancer drugs.
We hope during the transition period that NHS England and NICE address some the issues that we, patients, clinicians and other cancer charities have raised with them through the consultation process. We’ll continue to monitor the situation and raise our concerns with NHS England and NICE. In the meantime if you’ve had access to a bowel cancer drug through the CDF and would like to share your story with us please get in touch at firstname.lastname@example.org.
By Asha Kaur, Policy Manager