The Cancer Drugs Fund, which was set up at the prime minister’s behest to bring last-chance drugs to dying patients, is expected to have its soaring costs severely trimmed by an NHS England review. The move will draw attention to intense criticisms of what was one of the prime minister’s flagship health plans. Some doctors claim the fund is “an unethical political fix”.
Pharmaceutical companies have already expressed outrage because their drugs will no longer be bought through the fund and have warned that thousands of terminally ill cancer patients will lose crucial palliative care.
At the same time, other health experts say that the reining in of the fund – set up to promote expensive cancer medicines in priority to drugs for all other diseases – reveals its creation was merely a politically expedient move aimed at ending the embarrassment of tabloid tales about cancer patients being denied “life-saving” drugs. They want the CDF to be axed.
Professor Richard Sullivan, director of the Institute of Cancer Policy, London, explained: “The Cancer Drugs Fund was a cheap political fix. Worse, it is unethical. You cannot give priority to cancer over all other serious illnesses, including coronary ailments and dementia. These types of patients are just as deserving of expensive medicines as are cancer patients.”
The Cancer Drugs Fund was originally given a budget of £200m and powers to purchase cancer drugs, even though many had already been rejected because they were not considered to be cost-effective by the National Institute for Health and Care Excellence (Nice), the body that approves drugs for use in the health service. New cancer drugs can add months to patients’ lives, but can cost £90,000 a course.
These high price tags caused the fund’s budget to soar and an NHS England review was set up last year to investigate the CDF’s finances. Early reports of the review, to be published this week, suggest that cancer drugs such as Halavan, Avastin and Kadcyla may no longer be provided by the fund in order to cut its costs.
“Last year the Cancer Drugs Fund spent £280m on medicines,” said health economist Professor Karl Claxton, of York University. “That money did some good but it would have done a lot more if it had been spent elsewhere in the National Health Service.”
According to Claxton, 21,645 quality adjusted years of life – a measure of health improvement that is provided by a medicine – would have been added to patients’ lives if that £280m had been used by the NHS on all illnesses. By restricting this money to cancer fund patients, fewer than 5,600 quality adjusted years of life were added to lives.
“Quite frankly, this has been an appalling, unfair use of NHS resources,” Claxton added.
The issue was summed up by Mangesh Thorat, a cancer surgeon at Queen Mary’s Hospital London. “It is very hard to tell a patient there is a drug that could add several months to their lives but that we cannot afford to give it to them.
“On the other hand, in saying that cancer cases deserve exemptions from cost controls – while other diseases are not permitted these exemptions – is basic discrimination. You are saying that one type of disease is more important than any other type.
“In fact, the problem of high-cost drugs is always going to be with us. The Cancer Drugs Fund is completely the wrong answer to the issue.”
However the Cancer Drugs Fund was robustly defended by the lobby group which represents drug companies, the Association of the British Pharmaceutical Industry. Its calculations suggest the review will lead to about 9,000 cancer patients no longer having access to medicines provided through the fund.
“That is the number using the eight drugs whose manufacturers who have already been told they are no longer to be funded,” said an ABPI spokesman. “Given that there are many more drugs likely to be excluded when the full review is published, it is clear that thousands more will find themselves without these medicines.”
Nevertheless critics such as Sullivan insisted the fund has been extremely harmful. In its operations, Nice used to negotiate prices of new drugs with pharmaceutical firms and would eventually give approval after those companies agreed to lower their prices. The Cancer Drugs Fund allowed the companies to continue to demand top prices. As a result, its budget soared. “That’s why the fund is now trouble,” Sullivan added.
A different perspective was provided by Sarah Rawlings, of the Breakthrough Breast Cancer charity. “The Cancer Drugs Fund was always intended to be a short-term solution to soaring cancer drugs costs. We need to set up a proper mechanism to deal with the problem. Charities, the NHS, Nice, pharmaceuticals and doctors have all got to sit down and work one out – though it won’t be easy. If it was, we would have done it by now.”
Angela Kukula of the Institute of Cancer Research agreed. “Cancer drugs are a bit special but they are not so special that they need a separate agency to finance their use. A well-designed system to ensure that innovative but expensive medicines are made available for all serious illnesses should be able to accommodate cancer drugs’ special needs,” she added.
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