Cancer Drugs Fund needs overhaul, NAO investigation finds

The Cancer Drugs Fund is unsustainable in its current form because of overspending and a lack of evidence on the results it yields, according to a report from the National Audit Office (NAO).

Established in 2010 to improve access to cancer therapies not routinely available on the NHS, the scheme has exceeded its budget by 50% and no data exist to show whether it is having any effect on the health of patients, the NAO investigation found.

The report comes ahead of a consultation on proposals from NHS England and the National Institute for Health and Care Excellence (NICE) on reform of the scheme.

Since its inception, more than 74,000 patients have been approved to receive drugs through the fund, the NAO found.

While spending was initially kept under the allocated budget, since 2013 NHS England has overspent by 35%, its cost rising by £241m — an increase of 138%, the report said.

In 2014–2015, the total cost of the fund was £416m and, for the first time, NHS England had been forced to cut costs by removing some previously approved drugs from the list.

It has put forward a plan for a “managed access fund” to pay for new drugs for a set period before NICE determines whether they should be available on the NHS.

The NAO figures show that half of the patients receiving drugs through the fund to date had been given treatments already looked at by NICE but rejected for not meeting clinical or cost-effectiveness criteria.

Meg Hillier MP, chair of the committee of public accounts, says at a time when the NHS is facing increased pressures on funding, the fund cannot continue in the same vein.

“If patients are going to get access to the drugs they need, there has to be much better control of costs and proper assessment of whether these drugs are making a difference to the health of patients,” she says.

An NHS England spokesperson says a consultation on their plans would begin soon.

“The new system will be designed to provide the NHS with a more systematic approach to getting the best price for cancer drugs, meaning more treatments can be made available, and give a greater focus on evaluation, leading to the best drugs progressing swiftly to routine commissioning,” the spokesperson adds.

Others were quick to agree it was time to overhaul the current system.

Emma Greenwood, Cancer Research UK’s head of policy, says: “We now need to see wider reform of cancer drug funding — including reform of NICE — to ensure that the system can meet each individual patients’ needs.”

Richard Torbett, executive director, commercial, at the Association of the British Pharmaceutical Industry, points out that the report makes clear that the use of new cancer drugs in the UK still remains below the average in other comparable countries.

“We want to see many more patients benefitting from new and innovative medicines, including cancer medicines,” he says. “What is needed is a wholesale reform of NICE, which, along with NHS England, needs to develop a longer-term sustainable solution to the evaluation and commissioning of cancer medicines.”