The English Cancer Drugs Fund (CDF), set up to provide funding for those products that the National Institute for Health and Care Excellence (NICE) has not recommended for use or where their guidance isn’t yet available, remains controversial.
The English Cancer Drugs Fund (CDF), set up to provide funding for those products that the National Institute for Health and Care Excellence (NICE) has not recommended for use or where their guidance isn’t yet available, remains controversial. Initially penciled for closure in 2014, it is now planned to run to 2016. NHS England, the national agency that oversees the fund, has just been given a boost of a further £80m (US$133m) to the existing £200m (US$332m) a year that was already earmarked.
That the Fund has been boosted with additional money isn’t a big surprise, the fund was already overspent. Speculation was rife that either companies would have to provide (possibly additional) discounts or some products would have to be dropped from the CDF approved list. These were never going to be popular options to help NHS England stay in budget, not to mention cause a political headache as the Fund was a key election promise by the Conservatives in the run up to the last General Election. UK Prime Minister David Cameron has already said that if he’s re-elected next year, he’ll keep the Fund going. Finding a bit more cash might simply have been easier than pursuing more discounts or de-listing products in the Fund, at least in the short term.
The long term is a bit more complex. First there’s the reality check that even with the extra cash, it just isn’t enough to meet demand. That means a de-list is looking more likely (being referred to as ‘re-evaluation’ of drugs on the list). But perhaps it’s also likely that companies will face more pressure to discount a little deeper.
Those decisions may well be swayed by an increasingly heated debate being played out in the media, and undoubtedly behind closed doors, about just what is a fair price for new cancer medicines. NICE it seems is being portrayed less as the ‘bad’ guy, with companies instead being challenged on just why their prices are so high.
Roche in particular is subject to close scrutiny as it set a price of more than £90,000 a year for it’s breast cancer drug Kadcyla. That price, NICE has made clear, is set at a level that meant NICE could not recommend its use (a cost per Quality Adjusted Life Year of over £166,000 versus NICE’s usual £30,000 or so). Kadcyla is however available on the CDF. And as an added complexity, Roche was closely involved in work that many credit as setting the groundwork for the CDF, and paid for lobbying by a patient group credited with convincing Prime Minister David Cameron, of the need for the Fund. The Fund is therefore being seen as a ‘work around’ NICE and one that’s making people more and more uncomfortable.
Not only that, there’s an interplay with the 2014 Pharmaceutical Price Regulation Scheme (PPRS). The scheme insulates the NHS from national spend on branded medicines above an agreed growth rate, with companies paying back if that is breached. £74million has already come back into the Department of Health. Due to exemptions for new medicines, some have pointed out that it’s possible that industry is picking up the tab for high prices being paid by the CDF being supplied by a small number of companies.
The CDF was already unpopular, not least because if you don’t have cancer and you’re struggling to get a new treatment on the NHS you can rightly ask why cancer gets special treatment, but also because it didn’t seem to resolve the underlying issues about why NICE says no and what needs to change. The CDF has meant ducking the issues of how best to appraise cancer drugs and what price is fair to pay when we want to see continued research and development and better treatments in the future, but don’t want to go too far and overpay. Let’s hope that the latest changes don’t distract from getting on with that work.
Leela Barham is an independent health economist. You can access website here and contact her at firstname.lastname@example.org