In the last couple of weeks we’ve seen a number of articles in the press describing the Cancer Drugs Fund a ‘tragedy for patients’ and a ‘waste of money’.
In part, this has been sparked by a recently published academic study that also claimed that several the medicines on the fund did not add value to patients – even suggesting that some did more harm than good.
Sensationalist headlines about the cost of medicines are rarely a fair reflection of reality so I want to try and put the record straight on a couple of issues.
The academic study was based on clinical trial data that was available for medicines on the fund in 2015.
Several of these medicines had been approved early by regulators, who decided that there was an urgency in getting them to the patients who needed them.
As the authors themselves acknowledged, there was little real world data available on these medicines at the time.
The fact is it takes time, even after regulatory approval, to gather longer-term data to form a complete picture of the value of any medicine– the longer a medicine keeps someone alive the longer it takes to collect overall survival data, by definition.
This point was ignored by all commentators as far as I've seen.
NICE – one of the most stringent assessors of clinical and cost effectiveness in the world – is now relooking at all of the CDF medicines for routine use on the NHS.
20 of the 48 medicines in the study have now been reappraised. 12 have been recommended, eight have been optimised – ie. recommended for use in some patients – and none have been rejected. Surely these figures dispel the argument that the drugs in question are of no value?
17 more of the medicines are either undergoing appraisal or are scheduled.
Far from being a tragedy, the CDF has allowed over 100, 000 NHS patients to be treated with the latest modern medicines that they would not have otherwise received.
"The reality of drug pricing and NHS spend in the UK is far removed from the rhetoric we hear. Companies work continuously with government, Nice and the NHS to ensure medicines offer value for money and are affordable."
From Dr Richard Torbett's letter in the Financial Times
Having said all this, I do have some sympathy with the view expressed in the academic study that the CDF as a 'ring fenced fund' was not an ideal solution.
The trouble is we were – and for the most part still are – pretty far from having a perfect evidence-based way of allocating resources across the NHS.
I agree that we ought not to have needed the fund, but England was falling so far behind other countries in terms of access to cancer medicines at that time that something needed to be done. Not ideal, but it worked.
We now, of course, have a new CDF with a new way for companies to establish conditional terms with the NHS to allow time for data on the value of medicines to mature.
Time will tell whether this new approach will be seen as a success.
My only plea would be that, at the right time, we evaluate that success as objectively as possible.
Dr Richard Torbett additionally authored a Letter for the Financial Times, published on Wednesday 10 April 2017. It is available to view online here (£).