Only 56% of the government's £50 million interim Cancer Drugs Fund – or just under £27.5 million - was spent by Strategic Health Authorities (SHAs) in England during the time the Fund was available from October 2010 to March 31, 2011, new figures show.
This spending rises to just over £32.5 million (65%) if anticipated future costs are included for patients whose treatment was initiated before March 31, says leading charity the Rarer Cancers Foundation (RCF), in a new report evaluating the impact of policies to improve access to cancer treatments.
The study shows that 2,880 applications were made to the interim Cancer Drugs Fund during October 2010-March 31, 2011 (773 applications in March alone) and that, overall, 2,506 cancer patients gained access to treatment as a result of the Fund, although applications for 187 patients were denied.
It also reveals a dramatic north-south divide in approvals, with SHAs in the south of England approving a lower number of applications than those in the north. For example, NHS South Central approved around 75% of applications during the period whereas NHS North East approved every application it received, and while NHS South West used less than a quarter of its allocated funds, NHS Yorkshire and the Humber spent slightly more than its allocated budget.
Most SHAs have taken steps to expedite the application process for the Fund, with one - NHS East of England - removing the requirement for clinicians to submit exceptional-case applications before they can access the Fund. Also, six out of 10 SHA operate lists of drugs which will be routinely reimbursed through the Fund. "This approach reduces bureaucracy, enables rapid decision-making and provides greater certainty to clinicians and patients," says the RCF.
However, NHS North West’s operation of a negative list of drugs which will only be funded in exceptional circumstances breaches the spirit of the Cancer Drugs Fund policy, says the RCF, adding that, despite guidance instructing SHAs to cease using negative lists,NHS North West’s list was still operational on June 3, 2011.
The Fund could potentially benefit more than 30,000 patients, enabling them to access 34 treatments which would not have been routinely available on the NHS, and patients with bowel, kidney and blood cancers have been among the greatest beneficiaries, the report finds. The most-requested drug - by far - has been Roche's Avastin (bevacizumab), followed by Merck Serono's Erbitux (cetuximab), Novartis' Afinitor (everolimus), GlaxoSmithKline's Tyverb (lapatinib) and Roche's MabThera (rituximab).
Commenting on these findings, RCF chief executive Andrew Wilson said that while it was "great news" that thousands of patients have benefited from the Fund, it was concerning that 187 patients had been denied life-extending treatment "despite money going unspent and the emergence of significant regional variations in approval rates."
The report also looks at progress with Primary Care Trust (PCT) exceptional-case processes. It estimates that 7,743 applications were submitted between April 2007 and December 2010, and suggests that the substantial increase in application rates during October-December last year reflects the fact that many SHAs required clinicians to submit exceptional-case applications to PCTs before a treatment could be considered for reimbursement from the Cancer Drugs Fund.
October-December 2010 (the period in which the interim Fund was introduced) also saw a dramatic drop in the exceptional-case approval rate. This is likely due to more clinicians being encouraged to apply for treatments which would have stood little chance of being approved before the Fund was introduced, the Foundation suggests, although it adds that this requires further investigation.