Cancer Drugs Fund 'has not delivered meaningful value to patients or society'

Updated: 

The Cancer Drugs Fund offered little clinical benefit to patients, put people at risk of side-effects and was not good value for money, according to a new study.

The fund, which ran in England from 2010 to 2016 and cost more than £1 billion, aimed to increase access to cancer medicines not routinely available on the NHS.

It was set up by former Prime Minister David Cameron but has now been replaced by a fund more closely managed by the National Institute for Health and Care Excellence (Nice).

In a new study, published in the Annals of Oncology journal, researchers examined 29 drugs available through the fund in January 2015 for 47 different cancer indications.

They concluded that the majority of the drug indications were "based on studies that reported minimal to no benefit in survival."

Just 18 drugs (38%) had research showing a benefit in terms of how long patients would live.

The typical overall survival benefit for these drugs was an extra 3.1 months of life, with a range from 1.4 months to 15.7 months.

When quality of life and toxic side-effects caused by the drugs were taken into account, the majority of drugs failed to show any evidence of meaningful clinical benefit, the researchers said.

Furthermore, they argued that the benefit to patients in the "real world", as opposed to clinical trials, was probably even less, given that people in clinical trials are carefully selected, have fewer other health problems and tend to be younger.

There was also no useable data collected on what happened to people taking the drugs via the fund - such as measuring how long they lived, their quality of life and side-effects, they said.

"We conclude the Cancer Drugs Fund (CDF) has not delivered meaningful value to patients or society," the researchers said.

"There is no empirical evidence to support a 'drug only' ring fenced cancer fund relative to concomitant investments in other cancer domains such as surgery and radiotherapy, or other non-cancer medicines."

The team noted that Nice had rejected use of the CDF drugs for 55% of the cancer indications because they were not cost effective.

In 2015, the fund then removed drugs for 51% of the indications.

"Eighteen of these reversals were based on evidence that existed prior to the introduction of the fund, suggesting wastage of resources but equally that drugs were given that were ineffective and probably resulted in unnecessary toxicities for patients," Dr Ajay Aggarwal, academic clinical oncologist at the London School of Hygiene and Tropical Medicine, who led the study, said.

"From 2010 when it started, to 2016 when it closed, the Cancer Drugs Fund cost the UK taxpayer a total of £1.27 billion, the equivalent of one year's total spend on all cancer drugs in the NHS.

"The majority of cancer medicines funded through the CDF were found wanting with respect to what patients, clinicians and Nice would count as clinically meaningful benefit."

Dr Paul Catchpole, from the Association of the British Pharmaceutical Industry (ABPI), which represents the pharmaceutical industry, said: "Sensationalist and misleading headlines do nothing to help ease the misery faced by cancer patients.

"The authors acknowledge that no real world comprehensive outcomes data has been collected or published by the NHS on cancer drugs fund medicines to substantiate the claims.

"It is interesting to note that a majority of the medicines which were funded by the cancer drugs fund are now going on to be approved by Nice for routine use on the NHS.

"Undergoing this process has reaffirmed the clinical benefit of these medicines for cancer patients."

Professor Paul Workman, chief executive of the Institute of Cancer Research, said: "The old Cancer Drugs Fund was always just a sticking plaster and we welcomed its overhaul because it was too expensive, unsustainable and provided little certainty to patients and their doctors.

"The new, more evidence-based system, where Nice appraises all cancer drugs, should address some of the issues highlighted in this study.

"But while we support the rigorous drug evaluation that Nice carries out, it's essential that the new system continues to offer fast access to the most innovative and exciting cancer drugs.

"We need Nice to reform the way it evaluates drugs to place greater emphasis on how innovative they are, to ensure patients are not denied the most promising treatments purely because of their cost."

Emlyn Samuel, Cancer Research UK's senior policy manager, said the charity hoped that a new data collection on outcomes for patients would "help give patients better access to innovative cancer drugs".

Baroness Delyth Morgan, chief executive of Breast Cancer Now, said: "For many living with incurable breast cancer, the Cancer Drugs Fund has had a totally transformational impact on their lives, offering significant and precious extra time with their loved ones.

"This analysis actually makes clear that breast cancer drugs Perjeta and Kadcyla - which were not approved by Nice but which the CDF made available - provide a substantial improvement upon the current Nice-approved standard of care.

"But breast cancer patients are as disappointed as anyone that the major opportunity to collect real-world evidence on these drugs through the fund has been inexcusably missed.

"The fund was only ever intended as a sticking plaster to enable patients to access effective modern cancer drugs while the significant flaws in the Nice appraisal process were fixed. But, unfortunately, no effective reform has been forthcoming."

She said Perjeta can extend life by nearly 16 months, and Kadcyla by six to nine months, compared with existing treatments.

"In many cases, women will also be able to live relatively normal lives whilst taking these life-extending drugs, including working," she said.

A Conservative spokesman said: "The Cancer Drugs Fund is a policy that has given more than 100,000 people access to the latest drugs, meaning the chance of precious extra time with their families."