The National Audit Office has published the findings from its investigation into the Cancer Drugs Fund. The government set up the Fund in 2010 to improve access to cancer drugs that would not otherwise be routinely available on the NHS.
The Fund is unique in that no other condition has a dedicated fund to provide access to drugs not routinely available on the NHS. It was initially intended to run until March 2014, with a budget of £650 million, while a long-term pricing mechanism was worked out that would allow patients access to the drugs and treatments that their doctors thought would help them. In 2013, the government extended the Fund until March 2016. The Fund now has a total lifetime budget of £1.27 billion.
The key findings of this investigation are as follows:
• The Fund has improved access to cancer drugs not routinely available on the NHS. From October 2010 to March 2015, over 74,000 patients were approved to receive drugs through the Fund. Between 2009 and 2013, use of new cancer drugs (those launched in the previous 5 years) increased in the UK relative to the average in other comparable countries, although it remained below this average.
• 51% of the patients supported by the Fund between April 2013 and March 2015 accessed drugs that were appraised by NICE but not recommended for routine NHS commissioning because they did not meet its clinical and/or cost-effectiveness thresholds. The remaining patients accessed drugs that were in the process of being appraised, or had not been appraised, by NICE.
• More than 40 cancer drugs were available through the Fund at some point during 2013-14 and 2014-15, but the most common 10 drugs accounted for 71% of the patients supported.
• Due to a lack of data, it is not possible to evaluate the impact that the Fund has had on patient outcomes, such as survival. However, a data sharing agreement between NHS England and Public Health England, signed in July 2015, should enable the outcomes of patients supported by the Fund to be tracked.
• The cost of the Fund from October 2010 to March 2015 was £968 million, slightly above the allocated budget. In the early years of the Fund, the budget was underspent. However, taking 2013-14 and 2014-15 together, NHS England overspent the allocated budget by 35% and the cost of the Fund rose by £241 million – an increase of 138%. Over half of the rise was because of an increase in the average cost of treatment per patient and the remainder was due to an increase in the number of patients supported.
• NHS England has taken action to control the rapid growth of the cost of the Fund, including removing drugs on the grounds of cost for the first time. In March 2015, it stopped providing access to some drugs after a review of clinical effectiveness and cost, and in September 2015 it announced that it was proposing to remove more drugs from the national list of available drugs.
• All parties agree that the Fund is not sustainable in its current form. In July 2015, NHS England proposed that the Fund should become a ‘managed access’ fund that pays for promising new drugs for a set period before NICE decides whether the drugs should be routinely available on the NHS. The implication is that the Fund would no longer support the provision of drugs that have been appraised but not recommended by NICE. NHS England plans to consult on its proposals in autumn 2015, with the aim of implementing the new arrangements from April 2016.
total cost of the Fund, October 2010 to March 2015
patients were approved to receive cancer drugs through the Fund, October 2010 to March 2015
overspend on the allocated budget for the Fund for 2014-15
|39||cancer drugs that could treat 67 cancer conditions (indications) were available through the Fund in April 2015|
|19||cancer drug indications were removed from the Fund’s national list in March 2015|
|51%||of patients supported by the Fund have received drugs previously appraised but not recommended by the National Institute for Health and Care Excellence|
|19%||of patients supported by the Fund were approved to access one drug, Avastin, between April 2013 and March 2015|
|£416 million||total cost of the Fund in 2014-15|