The Cancer Drugs Fund has provided more than 10,000 patients with access to treatment in the first full year of its existence, but stark inequalities remain between the devolved nations of the UK.

More than 13,000 patients have now received treatment funded by the government's Cancer Drugs Fund between its (interim) launch in October 2010 and March 2012, accessing 94 different drugs under the scheme, according to a report by UK charity the Rarer Cancers Foundation.

And over the lifetime of the Fund, which is due to run until 2014, the group predicts that more than 44,000 patients will gain access to treatments at a cost of just over £508 million. 

However, access to cancer drugs is now "considerably greater" in England than it is in Scotland, Wales or Northern Ireland, the report has revealed. 

Patients in Scotland are three times less likely and those in Wales five times less likely to be treated with previously unfunded cancer drugs than their peers in England, while clinicians in Northern Ireland are eight times less likely to make requests on behalf of patients, highlighting the stark inequalities for patients in the UK. 

It seems there are also regional variations within England too, in terms of the number of applications made to the fund, as well as differences in the drugs that are routinely funded by each, that need to be addressed.

For example, for the year 2011/12, 1,396 CDF applications were approved and 66 rejected by the NHS West Midlands Strategic Health Authority, while just 688 were approved and seven denied by NHS Yorkshire and the Humber.

And there are clear differences in the approval rate when adjusted for population too; for example, NHS South East Coast has an approval rate over 50% higher than that in NHS North West, the charity claims.

NICE cancer rejections up?

According to the report, there has also been a significant rise in the number of cancer drugs rejected by the National Institute for Health and Clinical Excellence  for National Health Service use since the introduction of the Fund.

It claims that the Institute now rejects nearly 60% of the cancer treatments it appraises, a sharp increase on the rate of 40% before the CDF was introduced, despite extending the threshold for so-called end-of-life drugs and a dip in the average cost of new cancer medicines.

However, a spokesperson for NICE has refuted this claim, telling PharmaTimes UK News "their figures don’t tally with ours".

It stressed that 60% of all the cancer drugs it has appraised since March 2000 have been endorsed for NHS use, with a further 11% for certain patients or for use in clinical research, leaving just 29% outrightly rejected.

"As the numbers of cancer drug appraisals undertaken each year are relatively small, any variation in appraisal outcome from year to year is likely to be magnified and may not give a balanced overall representation of the typical decision outcomes," the spokesperson told PT.

The Institute also stressed that its appraisal process "has not changed" and that its independent appraisal committee "still makes its decisions the same rigorous manner, based on the evidence provided, as it did before the introduction of the Cancer Drugs Fund".

Elsewhere, there is growing concern over the seamless access to cancer drugs following the end of the CDF's current form in 2014.

New system "will protect patients"

It remains undecided what arrangements will be put in place after this date, but a spokesperson for the Department of Health told PT that there will be a system in place to protect patients accessing drugs through the Fund.

The Rarer Cancers Foundation has welcomed the Department of Health's decision that a small number of existing drugs - which may include previously unfunded cancer medicines - licensed before 2014 will be subject to value-based pricing when the new system is introduced.

But "the absence of a clear mechanism threatens to reverse the welcome progress that has been made in improving access to cancer drugs," the charity argues, and warns that, "unless action is taken to put in place alternative arrangements, we estimate that the result of this change would be to deny over 16,000 cancer patients life-extending treatment every year".