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‘Inefficient’ Cancer Drugs Fund has cut across work of NICE, say MPs

The Cancer Drugs Fund has not been managed effectively by the Department of Health and the NHS, the Commons Public Accounts Committee has found.

The government set up the Cancer Drugs Fund in 2010 to improve access to drugs that would not otherwise be available through the NHS.

But the committee’s report, published the day after World Cancer Day, finds that the Fund is inefficiently managed and unsustainable in its present form, and survival rates for cancer in England continue to lag behind those in similar countries.

Meg Hillier, MP for Hackney South & Shoreditch and PAC chair, said: “Cancer is a devastating disease. More than one in three people in England are expected to develop it in their lifetime and its impacts will affect the lives of many more.

“Against this backdrop the Cancer Drugs Fund has enabled thousands of people to receive drugs not normally available to them through the NHS. While this is welcome it’s also clear the Fund requires significant and urgent reform if it is to be sustainable.”

The cost of the fund grew by 138% from £175m in March 2013 to £416m in March 2015.

In 2014-15, despite increasing the Fund’s budget from £200m to £280m, NHS England overspent by £136m and had to defer planned spending on primary care services to cover the overspend.

NHS England only started taking action to control costs, such as reducing the number of drugs available through the fund, in November 2014, and still expects to have overspent by as much as £90m at the end of this financial year.

Although the fund was established to promote access to drugs for rarer cancers, most of the patients it supports have common types of cancer. Between April 2013 and March 2015, 59% of the patients being supported by the Fund had colorectal, prostate or breast cancer, three of the four most common types of cancer.

Half of the patients supported by the Fund received drugs that had been appraised but not recommended by NICE because they did not meet its clinical and/or cost-effectiveness thresholds. The MPs observed in their report: “The Fund has cut across, rather than complemented, the work of NICE.”

The report said: “In putting in place arrangements for the new Fund to be established from April 2016, NHS England should set clear objectives for what the Fund is seeking to achieve, and be prepared to take tough decisions to ensure that the Fund does not overspend.”

Hillier added: “A vital step in addressing the financial challenges must be to properly evaluate the health benefits of drugs provided through the Fund.

“If cancer patients seeking its support are to get the best possible treatment then there must be confidence that public money is being spent on the right medication, and at a fair price.

“We will be closely monitoring the progress made by the Department and NHS England in the months ahead.”

The report found that there is no assurance that the Department and NHS England are using their buying power effectively to pay a fair price for cancer drugs, including drugs paid for through the Fund, and that the department and NHS England do not have data to evaluate the impact of the fund on outcomes for patients, which they described as “unacceptable.”

The fund was initially set up as an interim measure until the government could introduce a long-term ‘value-based’ pricing system when the existing Pharmaceutical Price Regulation Scheme, which regulates the prices of branded drugs in the UK, expired in 2013. Instead, a value-based system was not introduced and the Department and the pharmaceutical industry agreed a revised Pharmaceutical Price Regulation Scheme that will run until 2018.

The committee recommended that the department should set out how it ensures that it pays a fair price for drugs and that the limit in the Pharmaceutical Price Regulation Scheme provides value for money for the taxpayer, outline lessons that can be learned from previous negotiations with pharmaceutical companies, and analyse the extent of regional variation in access to the fund.

The report also said that it was not clear whether NICE has the capacity to evaluate all new cancer drugs and should assess its capacity to do so as a matter of urgency.

Cancer Research UK say that the two most common factors behind the lower survival rate are patients being diagnosed later and poorer access to treatment.

Minister for life sciences George Freeman MP said: “We have invested more than £1bn into the Cancer Drugs Fund, which has already helped more than 84,000 people with cancer. However, as cancer charities and patient groups have said, it needs to evolve to reflect changes in the way drugs are developed.

"Alongside NHS England, we will consider the recommendations from the Committee and respond in due course.”

An NHS England spokesperson said: "This report comes just a day after new independent figures showing the NHS' great success in improving cancer care and survival rates for patients across England.

“While we welcome the Committee's support for a redesigned cancer drugs fund, we hope their explicit call for cuts to  cancer drugs prices charged to the CDF will be borne in mind as complex decisions on its future are taken in the next few months."


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