Cancer Drug Fund – update

Cancer Drug Fund – 20/01/15

The CDF team was recently forced to remove 20 drugs from the list of drugs they fund – in order to balance the budget allocated to them by the Department of Health.
The CDF was never supposed to become a permanent solution to the problem of funding cancer drugs.
Instead, NHS England was supposed to set in place an improved system, via Value Based Pricing, and via a reform of NICE.
To date, and in prime pre-election time, these changes have not yet been implemented, and therefore changes had to be made to how the funds for the CDF were going to be used.

In the article below, Peter Clark explains the decision and the broader issues of cancer drug funding.
He also talks about the difficulties of obtaining data that is “robust” enough for NICE – which is often a significant problem when assessing drugs for rarer cancers – as patient numbers are low.

MDS UK is glad to hear that NICE is considering changing their threshold, to reflect how the public views cancer.
It is clear that the public views cancer as a top priority – affecting people across all ages.

As a separate point on the CDF, MDS UK was slightly disappointed to hear how much importance is accorded to Quality of Life (QOL) issues – in relation to other data.  Furthermore, the CDF insists on QOL data collected during trials only – and peer reviewed data.
This is particularly frustrating for support groups who don’t necessarily have this type of data – but are able to supply plenty of QOL patient evidence – especially when such QOL of data is missing from clinical trials.
This decision to only accept a standard and established type of QOL date seems at odds with the CDF’s suggestion they would accept to fund those drugs where the evidence is still “uncertain”.

As a reminder – no MDS drugs were removed from the CDF list.
Both MDS licensed drugs are recommended by NICE:

  • azacitidine (Vidaza) – for Intermediate and high-risk MDS, AML and CMML
  • lenalidomide (Revlimid) – for isolated del 5q MDS

Only Del 5q with 1 other chromosomal abnormality is currently funded by the CDF.

Further article in the Pharmaceutical Journal – 20/01/15:

“Cancer Drugs Fund has undermined NICE, its chair admits”

Comments from its Chair, Peter Clark and NICE Deputy Chief Executive, Gillian Leng

“The Cancer Drugs Fund (CDF) has undermined the National Institute for Health and Care Excellence (NICE) and has provided a “get out of jail card” for pharmaceutical companies, says Peter Clark, the chair of the CDF.

In an address to the Westminster Health Forum on 15 January 2015, Clark, a practising oncologist, said he regrets that the CDF has undermined the NICE approval process and admitted that the system for commissioning chemotherapy in England is “broken”.

“CDF has stacked up drug indications with no long-term decisions about the future of [the fund],” said Clark.

The CDF budget for 2014–2015 is £280m but it is set to overspend by £110m, he said. In response to the overspend, a number of drugs and indications will be removed from the fund. Clark said the move, announced on 12 January 2015, was “inevitable” and that there would be further prioritisation of the drugs that are funded through the CDF.

To be eligible for CDF funding, cancer drugs are now assessed on clinical benefit versus cost but Clark conceded that the simple evaluation used by the CDF was “in no way a cost-effectiveness analysis or doing what NICE does”. “This is all we can do,” he said.

Clark wants the CDF to fund drugs that offer significant benefits to patients while they are appraised by NICE and to facilitate further data collection and evaluation.

In Clark’s vision, a positive decision from NICE would see the drug funded through “baseline commissioning” but a negative decision could lead to one of two things happening. Drugs that received a negative decision based on solid long-term data would be removed from the CDF. Where there was uncertainty about the drug’s effectiveness, further outcome data based on its use within the NHS should be collected. In turn, these data would be shared with the drug’s manufacturer, NICE and the CDF, at which point the drug would be reappraised by NICE, but this time with “mature data”.

“My view is that with this maturity-of-data process there will be many more NICE [approvals],” said Clark.

Clark believes that cancer has a special place in people’s psyche, which influences their willingness to pay for treatment. Gillian Leng, deputy chief executive of NICE, suggested that NICE may be asked to up the cost effectiveness threshold for cancer medicines. “If cancer is deemed a priority, then we’ll make it a priority,” she said.

A report by the National Audit Office was released on the same day as the Westminster Health Forum event. It reveals that cancer survival in the UK has improved since 2011 but remains about 10% lower than the European average.”

Citation: The Pharmaceutical Journal, 31 January 2015, Vol 294, No 7847, online | URI: 20067634

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