Number of patients eligible for fast track access to drugs through the cancer drugs fund is slashedBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2197 (Published 08 April 2013) Cite this as: BMJ 2013;346:f2197
The number of cancer indications for which patients can have fast track access to drugs not routinely available on the NHS through the cancer drugs fund has been halved by reforms announced by NHS England on 4 April.
NHS England, formerly the NHS Commissioning Board, has drawn up a national list of cancer drugs yet to be assessed by the National Institute for Health and Care Excellence, for which doctors in England can ask for fast track access for their patients. It argues that this will reduce the postcode lottery in access to drugs caused by funding decisions, which were previously made at a regional level through the 10 strategic health authorities.1
The national list contains 28 drugs to treat 64 different cancer indications.2 The charity Macmillan Cancer Support points out that this list has halved the number of cancer indications covered, which previously numbered 129.
Mike Hobday, head of policy and research at Macmillan Cancer Support, said: “It is worrying that the reduced list of cancer drugs that can be funded will restrict access to drugs which were previously routinely available. For rarer cancers, this will be particularly acute.”
Doctors will be able to nominate drugs to be considered for inclusion on the list and to make individual funding requests for cancer drugs not listed. Individual funding requests will be considered by four area teams—north of England, Midlands and the East, south of England, and London.
Sean Duffy, national clinical director for cancer at NHS England, said, “Having one consistent method for consideration of overall clinical benefit and funding means that all applications will be assessed by the same criteria. Regional variation of the past is clearly not acceptable for patients.”
NHS England has stressed that any patient who had already been approved for funding for a cancer drug not on the national list will still have that drug funded.
The government launched the cancer drugs fund in 2011,3 worth £200m (€236m; $305m) a year, after trialling a £50m fund in October 2010. The fund is due to be abolished at the end of March 2014. So far, 28 000 patients have had treatment paid for through the fund, and the fund’s chair, Peter Clark, has warned that demand for drugs is now so high that the fund is likely to run out of money.
“At some point this year we will have to give notice to the government and to patients that some treatments will no longer be available through the fund,” he told The Times.4 A “prioritising tool” based on measures including a drug’s effectiveness in delaying the progress of cancer and its effect on quality of life has been developed for use in the event of a cash shortfall.
The charity Beating Bowel Cancer has warned that up to 6500 new patients a year in England could be denied access to cancer treatments when the fund is wound up next year. Mark Flannagan, the charity’s chief executive, said: “There is still uncertainty for patients and clinicians about what will happen in the future, when the cancer drugs fund comes to an end.”
A spokesman for NHS England said that this was a matter for the Department of Health, but he added, “Work is being undertaken to review how access will be made to such drugs after March 2014.”
The cancer drugs fund is due to be replaced by value based pricing, which is intended to make a greater variety of drugs more widely available. Hobday said, “Currently it is unclear what that system will look like even though it is due to come into force next year.”
Heather Walker, policy manager at Cancer Research UK, said: “The Department of Health should publish details of the new value based pricing system—and what will happen to the cancer drugs fund—as a priority.”
Cite this as: BMJ 2013;346:f2197