In a hard-hitting report, the UK’s Public Accounts Committee has concluded that the Department of Health and NHS England have not managed the Cancer Drugs Fund (CDF) effectively, failing to control costs and improve access to treatments for rarer cancers.

The Fund was set up with the key aim of promoting access to new cancer drugs and drugs for rarer cancers but, in practice, most patients supported by it have had common types of cancer. Between April 2013 and March 2015, for example, 59% of the patients being treated through the CDF had colorectal, prostate or breast cancer, three of the four most common types of cancer.

Also, half of the patients supported by the Fund received drugs that had rejected by the National Institute for Health and Care Excellence after failing to meet its clinical and/or cost-effectiveness thresholds. “In this respect the Fund has cut across, rather than complemented, the work of NICE,” the PAC said. 

NHS England was slammed for failing to keep CDF costs under control. The cost grew rapidly in the two years to March 2015, rising by £241 million, or 138%, while in 2014–15, despite increasing the budget from £200 million to £280 million, NHS England overspent by £136 million (48%). 

Action to control costs was not undertaken until November 2014, after which a number of therapies were removed from the Fund. “Despite this and a further budget increase from £280 million to £340 million, NHS England still expects to overspend by between £70 million and £90 million in 2015-16,” the report notes.

The PAC also stressed that there is no assurance that the Department and NHS England are using their buying power effectively to pay a fair price for cancer drugs, including drugs paid for through the Fund, and asked whether more flexible pricing arrangements covering a number of medicines could improve value for money.

Elsewhere, the Committee said it is “unacceptable” that the Department and NHS England still don’t have data to evaluate the CDF’s impact on outcomes for patients five years after it was established, and have asked for a report on what the available data indicate by June. 

The report also highlights that it remains unclear how far regional variations in access have been reduced so that people across the country have equal access to the Fund, and whether NICE has the capacity to evaluate all new cancer drugs, as envisaged in the proposals for the new system.

CDF reform

NHS England is currently consulting on its proposals for CDF from after April this year, centred on a system for commissioning new cancer drugs that is fully integrated into NICE’s appraisal process.

Under the new process, drugs would be given a conditional recommendation by NICE and their use enabled by the CDF for a pre-determined period, whilst further evidence on the longer-term benefits, which may not be available at the time of licensing, is collected before deciding on their routine use on the NHS in future.

At the end of this period, the drug would go through a short NICE appraisal based on the additional evidence. At this point, a positive recommendation would take drug into routine commissioning, while a negative one would see it move out of the CDF and become available only on the basis of individual patient funding requests.