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Cancer Drugs Fund: The dilemma of striking a balance between drugs' accessibility and cost sustainability continues

16 March 2015 Kavita Rainova

As of 12 March, some of the drugs that were previously funded through the Cancer Drugs Fund (UK) have been de-listed. The news came shortly after the CDF changed its drug evaluation methodology at the start of 2015 and brought back into focus the questions over the evaluation of drugs. A survey carried out by doctors.net on behalf of Sanofi UK found that 79% of oncologists in the poll either 'agreed' or 'strongly agree' that "the cuts will compromise their ability to make optimal treatment choices for their patients". Additionally, 74% of the oncologists considered that the CDF "panel placed budgetary considerations ahead of what's best for cancer patients when they made their decisions about cuts to the CDF". The survey involving 115 senior oncologists, of whom 77 were prostate cancer specialists, points to the widespread disagreement over the CDF panel's decisions published in January this year.

What is the CDF?
The CDF was established in 2011 with the view of providing funding for cancer treatments that have been rejected for funding or have not yet received a funding decision by NICE, and that were not available within NHS England. The fund, which is currently set to run until March 2016, has been providing an extra GBP 200 million (USD300.6 million) annually to allow cancer patients to access treatments they otherwise wouldn't have been able to.

Last year, however, it was announced that the NHS will be conduct pricing negotiations and clinical-effectiveness assessments for drugs included on the CDF list. As a consequence, the CDF panel was set to re-assess, starting in December last year, over 40 indications already on the list as well as 10 new drugs. Its assessment was meant to focus on evaluation of cost in addition to the clinical benefit for the first time.

The result….
The re-evaluation decisions, which were published in January, resulted in 25 indications for 16 drugs removed from the CDF list. Of the 84 treatments that underwent revaluation, 59 were maintained. The de-listed drugs included a number of important new treatments in breast, prostate, and bowel cancer drug indications among others.

Access to treatments vs cost-containment dilemma
The re-evaluation brings with it the conundrum of ensuring access to treatments to patients while at the same time taking into account financial resource constraints.

Viewed from the point of view of finite resources, and the cost-containment climate in the UK, putting in place an evaluation of a treatment's clinical benefit in relation to its cost makes sense. It is aimed at ensuring the "best value for money" and supporting the fund's sustainability. The decisions from January are estimated by NHS England to result in GBP 80 million of savings.

On the other hand, when viewed from the point of providing patients with access to alternative methods of treatment, the decisions would undoubtedly have a negative effect. The Rarer Cancers Foundation, estimates that decision to remove a number of the drugs would impact around 7,700 patients.

Unsurprisingly, the decisions at the time of their publication attracted a fair amount of criticism from various charities. For example, the head of policy and campaigns at Breast Cancer Campaign, Mia Rosenblatt commented that breast cancer drug Halaven, for instance, had been the subject of more applications for CDF funding than any other breast cancer drug that were funded by the CDF, and that removing from the list was estimated to impact approximately 800 women per year. In the meantime, with respect to the removal of five bowel cancer treatments, chief executive of the charity Beating Bowel Cancer, Mark Flannagan, was reported to have stated that this meant that approximately two thirds of advanced bowel cancer patients "face the probability of an earlier death".

As the de-listing of the drugs came into effect last week, and the survey results were announced, the issue of CDF and its activities has come back under the spotlight. In addition to access issues, the poll also suggests that more questions could potentially be raised with regards to process itself. The Association of the British Pharmaceutical Industry had noted in January already that the "re-evaluation process was fundamentally flawed". Whether that is the case or not, and whether the CDF methodology will be in any way considered remains to be seen, but what is clear is that the issue of CDF and access to cancer medication will remain a hot topic for debate in the coming months.

Kavita Rainova is a life sciences analyst for IHS
Posted 16 March 2015

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