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Cancer Drugs Fund to axe drugs used for 27 treatments

The Cancer Drugs Fund (CDF) will cut funding for a further 16 medicines used for 27 separate treatments from 4 November, including those used for breast, pancreatic and blood cancers.

It will reduce the number of treatments NHS England covers by more than half since the beginning of the year, after projecting an over-spend of £70m this year without this reprioritisation.

Some drugs are being removed completely, while others are removed only for certain treatments.

The first ‘de-listing’ was announced in January, when 16 drugs for 25 cancer treatments were scrapped.

NHS England said that without de-listing the drugs from the list of publicly funded medicines, spending would rise to around £410m compared to its yearly £340m budget.

Oncologist Professor Peter Clark, chair of the CDF, said: “There is no escaping the fact that we face a difficult set of choices, but it is our duty to ensure we get maximum value from every penny available on behalf of patients.

“We must ensure we invest in those treatments that offer the most benefit, based on rigorous evidence-based clinical analysis and an assessment of the cost of those treatments.”

Though patients currently being treated with the axed drugs will not be affected by the changes, the Rarer Cancer Foundation said around 5,500 patients would eventually miss out on life-extending treatments.

NHS England justified the changes with a need to “ensure every penny is spent on the best available drugs at appropriate costs”, with decisions based on advice of clinicians and further evidence.

But the foundation deemed the cuts a disappointment and a “mess” between the NHS and the pharmaceutical industry.

Andrew Wilson, the foundation’s chief executive, said: “While we welcome the increase in the Cancer Drugs Fund budget, it’s deeply disappointing that NHS England intends to remove 25 treatments from the National List. We had hoped that the NHS would work with manufacturers to ensure that all treatments would remain available, meaning that cancer doctors could continue to be able to use the drugs that they think could most benefit their patients.

“Patients should never be the victim of a standoff between industry and the NHS. Both sides bear responsibility for this mess and both sides have a duty to try to fix it. There is now a two month notice period and we urge NHS England and pharma to work together in the interests of cancer patients to find a way to ensure these treatments remain available.”

He added that the cuts were a “symptom of a wider problem” stemming from a “complete failure” to reform NICE and change drug pricing in order to assess the benefits of new cancer treatments.

The recently published independent Cancer Taskforce recommended that NHS England work with NICE, charities, the government and pharmaceutical companies to develop a new system “aligned with NICE processes”.

NHS England and NICE will be consulting on a new system for commissioning cancer drugs, designed to provide the state service with “a more systematic approach" to getting the best price for these medicines.

Several other cancer organisations have spoken out against NHS England’s decision, with Breast Cancer Now saying that cutting Kadclya and Avastin will leave “just three drugs specifically targeting secondary breast cancer” via the fund.

Its chief executive Baroness Delyth Morgan said: “This is a dreadful day for breast cancer patients. Kadclya is a one-of-a-kind drug proven to extend life, and the fact is that, because the government, the NHS and the pharmaceutical industry have failed to agree realistic prices for new drugs, some women will die sooner.

“Despite many families relying on it, the CDF has unfortunately failed, and today’s delisting will further reduce the NHS’ ability to keep pace with Europe in the treatment of breast cancer.”

Professor Paul Workman, chief executive at The Institute of Cancer Research, London, said the decision was an example of “the confusion at the heart of our drug assessment system”, with some treatments being refused by NICE but accepted onto the CDF, yet later axed from the fund as well.

He added: “What we urgently need is a new unified system for evaluating treatments that can attract widespread support and ensure that the most innovative and effective cancer drugs reach the patients who need them as fast as possible.”

Deborah Lancaster, director of drug company Roche Products Ltd, said: “This second round of de-listing speaks to the need to reform the CDF, and we are ready to play our part in ensuring this happens.”

She explains more in the video below:

The CDF was launched by prime minister David Cameron in 2011 to make sure all cancer patients had access to appropriate drugs regardless of costs.

Despite drug cuts, it has seen an increase in budget of 70% since August 2014, when its funds jumped from £280m to £340m.

The full list of treatments dropped in both rounds of de-listing is here.