January 8, 2015

expert reaction to forthcoming review of drugs paid for by the Cancer Drugs Fund

NHS England is re-evaluating the availability of a number of drugs to patients through the Cancer Drugs Fund.

Dr Charlotte Chamberlain, Clinical Research Fellow, School of Social and Community Medicine, University of Bristol, said:

“The CDF has been seen as a ‘back door’ to funding high-cost cancer drugs on the NHS. Introducing negotiations with pharmaceutical companies over cost is overdue to prevent further unsustainable costs for the NHS.

“Unfettered access to cancer drugs, without thought to the opportunity cost of where else NHS money may be spent, such as on other proven cancer treatments, such as radiotherapy, is unfair. Robust assessment of the value cancer drugs bring to cancer survival and quality of life must be compared against the value of other cancer treatments – and treatments for other diseases.

“Despite agreeing that the re-evaluation of CDF drugs is necessary to establish their value to the NHS for cancer survival and quality of life, the prioritisation tool used by the CDF is untested and lacking a sound evidence base. At best it duplicates and undermines NICE decision-making and at worst, it distorts population priorities for treatment. If cancer drugs genuinely should be evaluated based on separate criteria to other treatments and other diseases then this needs to be established. If cancer should have pre-eminence in funding, then rather than duplicating resource and methodology with the CDF, decision making should be integrated into NICE where all treatments for cancer may be compared.”

Dr Paul Catchpole, Director of Value and Access, ABPI (Association of the British Pharmaceutical Industry), said:

“We deplore any decision to restrict or remove patient access to cancer medicines. We reiterate that we are very disappointed that NHS England did not address concerns about the flawed process they are following, raised by the ABPI and pharmaceutical companies, before proceeding to re-evaluate CDF medicines. Such a re-evaluation process would not be necessary if NICE quickly evolves the way it evaluates cancer medicines as part of more fundamental reforms.

“The NHS England mechanism for evaluating medicines is crude and there is a risk that by evaluating cancer medicines in this manner important costs and benefits will be missed out of the process, potentially resulting at best in misleading conclusions being drawn and at worst NHS patients being denied access to CDF medicines which do provide significant health benefit. The ABPI does not support such an approach; any further development of a value assessment process for CDF medicines should be undertaken by NICE. We urgently need a clear plan with a set of agreed timelines setting out how a sustainable solution will be achieved”.

Prof. Finbarr Cotter, Consultant Haemato-Oncologist, Barts Health NHS Trust, said:

Regarding Halaven (Eribulin), manufactured by Eisai:

“This is a drug with a new mechanism of action making it first in class that was assessed by NICE for the treatment of advanced breast cancer that had failed two prior chemotherapy regimens. The assessment acknowledged that it did work in this setting but was only marginally better than alternatives (approx 2-3 months of life extension) at a cost of around £70,000 pounds per QUALI. The cost for treatment was around £40,000. This was deemed to be too expensive for the NHS when considering the relatively short improvement in life extension and was therefore not approved for NHS patients to receive and be funded for treatment. It also has some toxicities that are unpleasant. Looking at the data from the trial and the evidence presented I am not surprised.”

Dr Mangesh Thorat, Research Fellow, Centre for Cancer Prevention, Queen Mary University of London (QMUL), said:

“This issue presents me with a dilemma – as a cancer clinician, I am happy that this Cancer Drugs Fund prevents my patients from being denied treatments towards end of their life, however, on the other hand I think this fund not only undermines NICE but also discriminates against patients in similar situations who have diseases other than cancer.”

Prof. Richard Sullivan, Director, Institute of Cancer Policy, said:

“The Cancer Drugs Fund has been one of the most poorly thought through pieces of health public policy. The rationale for setting this up for only cancer was poor. There was almost no in-built oversight to actually ascertain whether those drugs on the CDF were actually leading to improvements in survival or quality of life, relative to the toxicity they caused. The provision of an exceptional fund for just cancer medicines made no sense in with respect to much greater financing needs for radiotherapy and surgery, which are the primary methods of cancer control and cure, thus failing tests of fairness.  The CDF was a ‘cheap’ way to avoid the critical socio-political problem which is why some cancer medicines cost so much when they deliver only marginal benefits in terms of clinical benefit.”

Prof. Karl Claxton, Professor of Economics, University of York, said

“The evidence suggests that much greater improvements in health outcomes for NHS patients would have been possible across a range of diseases (including cancer) if the substantial resources of the CDF had been made available to the NHS. There is no doubt that the CDF has done more harm than good for NHS patients overall. The real beneficiaries of the CDF are manufacturers who have been able to sell their drugs to the NHS at prices that are unaffordable.”

Declared interests

Prof Richard Sullivan has unrestricted educational grants from Novartis and Pfizer, and has received lecture honararia from Easi, Novartis, and Pfizer – all this goes to the Institute of Cancer Policy.

Prof Karl Claxton is a faculty member of the Roche Payer Evidence Council.