Proposed new arrangements for prioritising access to the Cancer Drug Fund “will continue to undermine NICE, duplicate effort and distort allocation of NHS resources, while failing to support the development of cost-effective drugs from which patients will benefit,” says a team of leading health economists.

The proposals put forward by the CDF following its recent consultation include the introduction of a rationing process to prioritise the drugs on its list so that the Fund remains within budget, says the team, from the Office of Health Economics (OHE). “In other words, [the CDF] will do a crude reassessment of the cost-effectiveness of the drug – something that NICE has already assessed and found unacceptable,” they write, in recent editorial in the British Medical Journal (BMJ).

Instead, they propose that the Fund should focus on those cancer drugs that may be cost-effective but for which current evidence is insufficient. This process could be: 

- NICE considers new drugs, as at present; 

- it identifies cancer drugs for which evidence is too uncertain for a positive recommendation but further research might show they are cost-effective; 

- these drugs are considered by a joint NICE/NHS England group that decides, with expert advice, whether at the manufacturer’s price further research would justify its cost;

- the group also decides whether in the meantime the drugs should be generally available through the CDF or only to patients involved in the research; and

- when the research is complete, NICE would reappraise the evidence and decide whether the drug should now be recommended as cost-effective.

If, as is likely, the number of drugs suitable for further research still exceeded the capacity for funding, prioritisation would be on the basis of the potential value to the NHS of the additional research, the authors propose.

The CDF would cover the costs of the drugs, with a flexible pricing agreement, while the presumption should be that the manufacturer would fund and, where feasible, undertake the research, because it is designed to show that the drug is cost-effective at the company’s price, they write.

Other possible sources for these research funds could be the rebated income from companies under the current Pharmaceutical Price Regulation Scheme (PPRS) and other sources of funding aimed at encouraging and supporting pharmaceutical innovation, they suggest, and emphasise that, if the public sector were to fund the research, it would need to be clear how the NHS shares the return on that investment, which would obviously be linked to the price it pays for the products.

The authors also point out that if the value of their proposed process could be shown for cancer treatment, there is no reason why its remit and funding could not be extended to other therapeutic areas in the future