UK cancer fund was poor value and may have caused patient suffering

[April 28, 2017] By Kate Kelland

LONDON (Reuters) - A special U.K. Cancer Drugs Fund (CDF) set up in 2010 spent over 1.2 billion pounds ($1.55 bln) but failed to deliver value for patients or society and may have caused unnecessary suffering, an analysis has found.

Specialists looked at 29 cancer medicines approved for funding by the CDF in January 2015 for 47 specific cancer conditions and found only 38 percent were based on data showing the drugs were likely to help patients live longer.

The average overall survival gain was just over three months, but it ranged from barely 6 weeks up to 15.7 months.

When other factors such as quality of life and toxic side effects of the drugs were considered as part of criteria developed by oncologists to measure value to patients, most of the drugs failed to show any meaningful clinical benefit.

"From 2010 when it started to 2016 when it closed, the Cancer Drugs Fund cost the UK taxpayer a total of 1.27 billion pounds, the equivalent of one year's total spend on all cancer drugs in the NHS," said Ajay Aggarwal, an oncologist at London School of Hygiene & Tropical Medicine.

"(Yet) the majority of cancer medicines funded through the CDF were found wanting," said Aggarwal, who co-led the study, which was published in the Annals of Oncology journal.

Aggarwal and his co-author Richard Sullivan, director of King's College London's Institute of Cancer Policy, also noted that when in 2015 the CDF conducted its own review of the value of drugs in its scheme, it removed them for 24 of 47 conditions.

"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," Aggarwal said.

CONFLICTS WITH DRUGMAKERS

The CDF, which was designed to help patients receive cancer drugs not routinely paid for by the National Health Service (NHS), frequently ran into conflict with drugmakers over its choice of what it did and didn't consider cost effective.

The chief executive of the Swiss pharmaceutical firm Roche, the world's biggest maker of cancer drugs, last year called the CDF system "stupid" and said it could jeopardize drug research and development.

Sullivan said the original decision to set up the ring-fenced CDF system was taken "despite a lack of evidence" that it might improve outcomes for cancer patients.

"We recommend that other countries ... considering similar ring-fenced drug access funds for high-cost cancer drugs should adopt a more rational approach," he said.

The CDF closed in March 2016 because it was financially unsustainable and replaced with a new-look CDF in July 2016.

The new CDF provides managed access to new cancer medicines for a limited time if the clinical and cost effectiveness of the drug is still not certain enough for it to be approved by the National Institute for Health and Care Excellence (NICE), which agrees which medicines can be funded via the NHS.

Sullivan said the new system "addresses some of the problems with the old CDF". But he still questioned whether it was fair.

"Why should cancer medicines be treated in this way, and not all medicines and indeed all (medical) technologies?" he asked.

(Reporting by Kate Kelland; Editing by Tom Heneghan)

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