Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Aug 1;28(8):1738-1750.
doi: 10.1093/annonc/mdx110.

Do patient access schemes for high-cost cancer drugs deliver value to society?-lessons from the NHS Cancer Drugs Fund

A Aggarwal  1   2 , T Fojo  3 , C Chamberlain  4 , C Davis  5 , R Sullivan  2
Affiliations
Review

Do patient access schemes for high-cost cancer drugs deliver value to society?-lessons from the NHS Cancer Drugs Fund

A Aggarwal et al. Ann Oncol. .

Abstract

Background: The NHS Cancer Drugs Fund (CDF) was established in 2010 to reduce delays and improve access to cancer drugs, including those that had been previously appraised but not approved by NICE (National Institute for Health and Care Excellence). After 1.3 billion GBP expenditure, a UK parliamentary review in 2016 rationalized the CDF back into NICE.

Methods: This paper analyses the potential value delivered by the CDF according to six value criteria. This includes validated clinical benefits scales, cost-effectiveness criteria as defined by NICE and an assessment of real-world data. The analysis focuses on 29 cancer drugs approved for 47 indications that could be prescribed through the CDF in January 2015.

Results: Of the 47 CDF approved indications, only 18 (38%) reported a statistically significant OS benefit, with an overall median survival of 3.1 months (1.4-15.7 months). When assessed according to clinical benefit scales, only 23 (48%) and 9 (18%) of the 47 drug indications met ASCO and ESMO criteria, respectively. NICE had previously rejected 26 (55%) of the CDF approved indications because they did not meet cost-effectiveness thresholds. Four drugs-bevacizumab, cetuximab, everolimus and lapatinib-represented the bulk of CDF applications and were approved for a total of 18 separate indications. Thirteen of these indications were subsequently delisted by the CDF in January 2015 due to insufficient evidence for clinical benefit-data which were unchanged since their initial approval.

Conclusions: We conclude the CDF has not delivered meaningful value to patients or society. There is no empirical evidence to support a 'drug only' ring fenced cancer fund relative to concomitant investments in other cancer domains such as surgery and radiotherapy, or other noncancer medicines. Reimbursement decisions for all drugs and interventions within cancer care should be made through appropriate health technology appraisal processes.

Keywords: cancer economics; clinical benefit scales; health policy; health technology assessment; patient access schemes.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Current status of the CDF Nov 2016.
See this image and copyright information in PMC

Comment in

References

    1. Davies JE, Neidle S, Taylor DG.. Developing and paying for medicines for orphan indications in oncology: utilitarian regulation vs equitable care[quest]. Br J Cancer 2012; 106: 14–17. - PMC - PubMed
    1. House of Commons Committee of Public Accounts. Cancer Drugs Fund—20th Report. House of Commons, 2016.
    1. NHS England Clinical Effectiveness Team. NHS England Consultation: Proposals for a Sustainable Cancer Drug Fund. NHS England, 2014.
    1. NHS England. National Cancer Drugs Fund List. 2015.
    1. Ryan C, Smith M, Fizazi K. et al. 753O final overall survival (OS) analysis of COU-AA-302, a randomized phase 3 study of abiraterone acetate (AA) in metastatic castration-resistant prostate cancer (MCRPC) patients (PTS) without prior chemotherapy. Ann Oncol 2014; 25: iv255–iv255.

Substances