Cards on the table. I don’t like the Cancer Drugs Fund, never have. In fact, having reported on it extensively, I have never spoken to anyone, on the record or off, who thinks the CDF, introduced as a temporary fix, is a good idea.
Since its launch in 2011, while some patients have had access to life-extending innovative treatments, it became very clear very quickly that the £200 million set aside for the CDF would not be enough to meet demand. Even raising that to £340 million could not prevent the removal of some therapies, leaving patients in limbo.
It was therefore welcome news to hear that the National Institute for Health and Care Excellence and NHS England have begun a 12-week consultation on draft proposals outlining new arrangements for the CDF. Plainly put, the proposal is that the CDF will become a ‘managed access’ fund for new cancer drugs to give early access to those which appear promising but which have “currently uncertain evidence bases which are insufficient to support a recommendation for routine commissioning”, NICE notes.
New cancer drugs will normally receive a clear ‘yes’, ‘maybe’ (CDF funding for a time-limited period), or ‘no’ funding decision within 90 days of market authorisation. NICE says it will enable patients to receive new treatments that cannot yet be recommended for routine use but which have genuine promise, while real-world evidence is collected for up to two years on how well they work in practice. The new scheme would operate from April 2016.
Some people believe this is a step in the right direction but I fear that we may be facing the wrong way. If we are looking to have early access to medicines, perhaps we should cast our eyes in the direction of the aptly-named Early Access to Medicines Scheme (EAMS).
Through EAMS, some patients have been receiving highly innovative cancer therapies before they had a licence and the scheme is complemented by a new NICE technology appraisal and NHS England commissioning process. It is currently funded by pharmaceutical companies and while such a financial arrangement is not sustainable long-term, it seems to me that this type of model – with the government, pharma companies, NICE, the NHS and yes, patients – working together to ascertain the real value of a medicine is one that is worth developing further.
The new CDF scheme is scheduled to begin at the same time as Sir Hugh Taylor’s Accelerated Access Review will present its report and recommendations. An interim report, published in October, set out five propositions to speed up access to transformative health technology and interestingly the first of those is “putting the patient centre-stage”.
Sir Hugh said patients were “vital at every step of the innovation pathway and that they needed to be supported to better understand and drive forward decisions about their treatment and care”. His team are looking at a structure that will “systematically facilitate patient feedback on and awareness of innovative products, as well as give innovators better opportunities to hear from patients about the innovations they want and need”. Could the same be said about the CDF? Nope.
The other four propositions are ‘getting ahead of the curve’, ’supporting all innovators’, galvanising the NHS and ‘delivering change’. Admirable sentiments and the interim report is the result of input by over 600 people and organisations working right across the development pathway, including clinicians, patients, the life sciences industry and researchers. You can read the interim report here.
Sir Hugh says he will work with his review team “to flesh out these propositions in ways that will be effective and will make a real and lasting difference to patients, system users, business and the NHS”. We wish him well.
“Real and lasting”, something that the CDF will never be. As with other old sticking plasters, the best place for it is the bin.
About the author
Kevin Grogan has almost 20 years experience as a journalist writing about the pharmaceutical and healthcare sectors and was most recently senior news editor at PharmaTimes before going freelance earlier this year. He currently writes for a wide variety of publications on both sides of the Atlantic, advises companies about their communications strategies and often appears on television and radio to discuss the pharma industry. A fluent Spanish speaker, he likes Manchester United and listening to old men with funny voices, mainly Bob Dylan and Leonard Cohen.
Follow him at www.twitter.com/kevinatgrogan