Intended for healthcare professionals


Reforming the Cancer Drug Fund

BMJ 2014; 349 doi: (Published 28 November 2014) Cite this as: BMJ 2014;349:g7276
  1. Martin Buxton, emeritus professor 1,
  2. Louise Longworth, reader in health economics1,
  3. James Raftery, professor of health technology assessment2,
  4. Mark Sculpher, professor of health economics 3,
  5. Adrian Towse, director 4
  1. 1Brunel University London, London, UK
  2. 2University of Southampton, Southampton, UK
  3. 3Centre for Health Economics, University of York, York, UK
  4. 4Office of Health Economics, London, UK
  1. Correspondence to: J Raftery j.p.raftery{at}

Focus on drugs that might be shown to be cost effective

The Cancer Drug Fund was originally conceived as a temporary measure, until value based pricing for drugs was introduced, to give NHS cancer patients access to drugs not approved by NICE. Spending on these drugs rose from less than the £50m (€63m; $79m) budgeted for the first year in 2010-11 to well over £200m in 2013-14, and the budget for the scheme—now extended for a further two years—will reach £280m by 2016.1 The recent changes to the fund recognise the impossibility, within any sensible budget limit, of providing all the new cancer drugs that offer possible benefit to patients. More radical changes are needed to the working of the fund, given the failure to introduce value based pricing, so that it deals with the underlying problem of inadequate information on the effectiveness and cost effectiveness of new cancer drugs when used in the NHS.

A recent The BMJ briefing identified major problems with the fund.2 The opportunity costs in terms of the treatments that cannot, as a result, be afforded elsewhere in the NHS are substantial, with consequent decrements to other patients’ health. Its operation undermines the role of the National Institute for Health and Care Excellence (NICE). A rejection from NICE on the grounds that a drug is not cost effective (at the price proposed …

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