September 4, 2015

expert reaction to changes to the Cancer Drugs Fund

It has been announced that the Cancer Drugs Fund will no longer pay for a number of medicines which were previously available.

Prof. Lesley Fallowfield, Director of the Sussex Health Outcomes Research & Education in Cancer, Director, and Professor of Psycho-Oncology, University of Sussex, said:

“I am no apologist for NICE and some of its decisions have raised eyebrows, however the Cancer Drugs Fund was always a political nonsense circumventing a defined process. Drug companies have only themselves to blame for trumpeting sometimes very small incremental benefits of drugs priced at what they think the market will bear rather than offering clear justifications for the costs. Furthermore and importantly, if pharma bother to include patient reported outcomes, then these will tell you very much more about harms as well as benefits or side effects for example from a patient’s point of view. Unfortunately even when this has been measured the companies have often chosen poor instruments or analysed the data badly.

“Of course anyone with a loved one with cancer or suffering from the disease themselves may find it outrageous that they can’t access some of these very expensive drugs. Sadly we have a finite budget and infinite demands. Someone has to make horrible, difficult, budgetary decisions – provision of some of the delisted drugs would mean that many hips would not be replaced, respite care for families looking after chronically sick kids or parents with dementia denied, and other rarer chronic diseases not treated at all. This sorry reality means that, like King Solomon dividing the baby in half, no one really wins. It is not fair either to criticise the NHS – escalating costs for cancer drugs is a global problem.”

Dr Matt Kaiser, Head of Research at Bloodwise (blood cancer charity), said:

“Today’s announcement will remove the only hope of effective treatment for many blood cancer patients. The existing system for approving new cancer drugs is clearly failing patients. Many blood cancer patients will be left in limbo until a long term solution is put in place next year. For some this will be too late. These drugs have been recognised as being clinically effective, yet patients in England will be denied access purely because the current system is broken.

“Brentuximab was only added to the Cancer Drugs Fund in January. There is a strong consensus among doctors that the drug represents a real step change in treatment for the two lymphoma indications that have been delisted. Its removal will be a disaster for these patients.

“Ibrutinib is a highly effective treatment for chronic lymphocytic leukaemia available widely throughout the world. For some patients the alternatives are extremely limited and have devastating side-effects. Its removal represents a huge step backwards.

“The Cancer Taskforce recently published its recommendations for improving cancer care to comparable levels of the rest of Europe. Ensuring that patients have access to the best drugs available is surely a key part of this.”

Dr Charlotte Chamberlain, Clinical Research Fellow, University of Bristol, said:

“Prioritisation within the NHS is a fact of life. Often it is hard to define the population who are being disadvantaged by paying more for another treatment. But, with the Cancer Drugs Fund prioritisation, one cancer drug is compared against another, so the population of cancer patients who benefit can be compared with the population of cancer patients who are being ‘de-prioritised’.

“Prioritising one cancer drug over another cancer drug is only ‘fair’ where the tool used to decide those priorities is fair. Otherwise, some cancer patients are marginalised for the wrong reasons – for instance, where overall survival from a cancer is treated the same as disease which has not progressed on a scan, but which may ultimately not improve overall survival. This occurs with the Cancer Drugs Fund tool. The current Cancer Drugs Fund prioritisation tool is not evidence based and has not been widely validated.

“Of the 16 drugs (25 cancer treatment indications) removed from the Cancer Drugs Fund in the latest round of prioritisation, many also score lower on a tool designed and validated by the European Society for Medical Oncology (ESMO) which assesses clinical benefit from cancer drugs. The ESMO tool prioritises treatments according to unbiased analysis of the clinical benefits they deliver to patients. The overlap in the two tools is reassuring. But, where the two tools diverge, on drugs such as Radium 223 (for use in metastatic prostate cancer) there is a real cause for concern that the CDF tool may not be fairly accounting for the clinical benefit of a treatment. NICE processes for establishing what provides the best care, with the best value for money in health funding, has been used for over 15 years in England. The exemption of cancer drugs from this process or from other validated processes like that introduced by ESMO is of concern.”

Prof. Paul Workman, Chief Executive at The Institute of Cancer Research, London, said:

“Today’s decision is an example of the confusion at the heart of our drug assessment system – with some treatments first being refused by NICE, then accepted onto the Cancer Drugs Fund and now to be removed from the list and denied to new patients. 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.”

* http://www.england.nhs.uk/ourwork/pe/cdf/cdf-drug-sum/

Declared interests

Prof. Lesley Fallowfield: “I have received research grant funding from: Roche, GSK and Bristol Myers Sqibb. I have had consultancy, speaker and advisory board funding from: Roche, Pfizer, Eisai, AZ, Sanofi, Amgen and Teva.”

Dr Charlotte Chamberlain: “Recently funded by the National Institute for Health Research for three years to investigate access to cancer drugs in the NHS. Currently employed as a public health doctor with an honorary contract with the University of Bristol.”

Dr Matt Kaiser: No interests to declare.

None others received.