England’s Cancer Drug Fund has improved patient access to novel cancer drugs not routinely available on the National Health Service, but is not sustainable in its current form, an investigation by the National Audit Office has concluded.

From its birth in October 2010 to March 2015, the Fund enabled more than 74,000 patients to receive drugs that had either been rejected for NHS use by cost regulators or hadn’t been through an appraisal yet, at a cost of £968 million.

Use of new cancer drugs (on the market for less than five years) between 2009 and 2013 significantly increased in the UK relative to the average in other comparable countries, and while there is no direct evidence it is thought that the CDF has played a significant part in this. But, at 92% of the international average, there is still room for improvement.

Also of note, while a key objective of the CDF was to give patients with rare cancers access to lifesaving treatments less likely to be appraised by NICE, the investigation found that most supported by the Fund had common types of cancer. In 2013-14 and 2014-15, 26,000 (or (59%) of the patients supported were being treated for colorectal, prostate and breast cancer, three of the four most common types.

According to the NAO, the CDF is now on track to overspend its allocated budget for 2014/15 by 48%, and it has reiterated the widely accepted view that the system not sustainable in its current form - despite two rounds of cut-backs this year which have resulted in the loss of 48 different therapies from the approved list.

'Wholesale' reform

“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,” said Richard Torbett, executive director, commercial, at the Association of the British Pharmaceutical Association, and expressed a commitment to “working with all parties to achieve a more joined-up system which allows many more NHS patients to benefit from life-enhancing medicines”.

NHS England has suggested the introduction of ‘managed access’ fund that pays for promising new drugs for a set period before NICE decides whether they are cost-effective enough for the NHS. However, this implies that the Fund would no longer support the provision of drugs rejected by the cost watchdog. 

The proposals are to be consulted on this autumn, with new arrangements implemented from next April.