The Cancer Drugs Fiddle

Oops! It’s actually called the Cancer Drugs Fund, isn’t it! And it was supposed to be a British government initiative, not a Conservative Party vote winner.

Since 2010, the Cancer Drugs Fund has treated around 80,000 people, at an average cost of £16,000 per person. The total cost was £1.27bn. Which, incidentally, is about the same amount of money as Osborne wanted to free up with his disability cuts in the 2016 budget.

The cancer drugs spend would be fine, if the drugs worked.

But we just don’t know. The BMJ is explicit that: “nobody has followed up the patients assiduously enough to put a value on the benefits”.

The Public Accounts Committee said this was unacceptable, and that the Department of Health and NHS England “have not managed the fund effectively”.

Let’s stand back for a moment.

David Cameron created the Cancer Drugs Fund for exceptional cases which weren’t going to be funded by NICE. But it’s become “a pretty mainstream part of cancer treatment”.

And it repeatedly busts its budget.

NICE made cost effectiveness as well as clinical effectiveness a key part of decisions about what the NHS should and should not provide. It’s tried to balance the needs of tax-payers, individual patients, clinicians, and the life science industries. It’s tried to be robust, inclusive, transparent, independent and contestable.

The Cancer Drugs Fund has been described as “the biggest single thing that has undermined the role of NICE”.

Michael Rawlins, the chair of NICE for its first 13 years, Mike Richards (then the government’s ‘cancer tsar’), and Bruce Keogh (then medical director of the NHS), all urged Andrew Lansley not to go ahead with the Cancer Drugs Fund. “There are plenty of other rotten diseases out there,” they told the health secretary. So why just cancer?

And the fund made it less likely that companies would agree a deal on the cost of the drugs through ‘patient access schemes’, pushing up their cost to the NHS. ‘It was obvious, however, that Lansley had no alternative as his boss [David Cameron, the prime minister] had made a promise’, Rawlins says.

Now, however, the judgment on cost effectiveness is returning to NICE. As well as saying yes or no, NICE can opt to approve a drug’s use for a limited time in a designated number of patients to provide firmer data on effectiveness and cost effectiveness. This is what the existing Cancer Drugs Fund has failed to do.

Still, though, the fund applies only to cancer drugs. This still feels so unfair!

Read more about how even the boss of the Cancer Drugs Fund regretting it being set up: here.

And more on the Cancer Drugs Fund here and here.


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