While the Cancer Drugs Fund has benefited more than 60,000 patients since it was established in 2010, it makes no sense. It was created as a buffer for politicians from both the health technology assessment carried out by NICE and from individual patient decisions. Prime Minister David Cameron pledged – as an election promise – that any patient could get any drug provided their consultant made the request, but times have changed. This clearly could never work in an era of dramatic super-inflation with little meaningful survival benefit.
The more we spend on healthcare the better the outcome. But there’s a vertical limit, a therapeutic plateau, where the benefit begins to dwindle. And we see this with the current delisting of 25 treatments under the CDF. All the delisted drugs were unduly expensive without giving meaningful clinical gain. Of course, personalised medicine strategies with molecular signatures could change this but very few drugs actually have specific response markers to guide therapy.
Predictably, the cancer charities were in uproar and the usual suspects were appropriately outraged. The real problem is that drugs cost what the market will bear without any relationship whatsoever to outcome. The loud protests of senior pharma executives, synchronised by their PR advisers, cuts no ice with hardnosed NHS managers.
But I predict the CDF will soon disappear completely because it is unsustainable, and NICE will become the only approval body in town. Self-pay will return for those who can afford it; and special insurance policies for cancer are already being developed.
The NHS will provide less and less across the board over the next decade; it’s inevitable given the massive increase in the numbers of older people with multiple co-morbidities consuming 80% of its budget. That’s driving drastic cost control everywhere, lengthening emergency room waits, mental health services, as well as access to precision radiotherapy and innovative medicines. My only surprise is that the drug cull happened so close to an election: cancer is a very emotive disease.
Professor Karol Sikora is an oncologist, and dean of the University of Buckingham Medical School