Intended for healthcare professionals


Cancer Drugs Fund requires further reform

BMJ 2016; 354 doi: (Published 27 September 2016) Cite this as: BMJ 2016;354:i5090
  1. Richard Grieve, professor1,
  2. Keith Abrams, professor2,
  3. Karl Claxton, professor3,
  4. Ben Goldacre, senior clinical research fellow4,
  5. Nicholas James, professor5,
  6. Jon Nicholl, professor6,
  7. Mahesh Parmar, professor7,
  8. Chris Parker, consultant oncologist8,
  9. Jasjeet S Sekhon, professor9,
  10. Liam Smeeth, professor10,
  11. David Spiegelhalter, professor11,
  12. Mark Sculpher, professor3
  1. 1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
  2. 2Department of Health Sciences, University of Leicester, Leicester, UK
  3. 3Centre for Health Economics, University of York, York, UK
  4. 4Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
  5. 5University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  6. 6School of Health and Related Research, University of Sheffield, Sheffield, UK
  7. 7Medical Research Council Clinical Trials Unit, University College London, London, UK
  8. 8Institute of Cancer Research: Royal Cancer Hospital, London, UK
  9. 9Travers Department of Political Science, Department of Statistics, University of California, Berkeley, CA, USA
  10. 10Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine
  11. 11Statistical Laboratory, Centre for Mathematical Sciences, Cambridge, UK
  1. Correspondence to: R Grieve richard.grieve{at}

Reliance on “real world” observational data undermines evidence base for clinical practice

The reforms to the Cancer Drugs Fund implemented in July were an excellent opportunity to generate evidence on the effectiveness of new cancer drugs.1 Unlike under the previous arrangements, data on patients’ outcomes will have to be collected for all drugs funded by the scheme. However, the reforms’ stated reliance on “real world” (observational) data will not generate reliable evidence of effectiveness. We propose an alternative model, using timely randomised controlled trials within routinely collected data sources, to establish which drugs are relatively effective. The current arrangement encourages early access to drugs, with high prices but uncertain benefits, whereas our proposal will provide high quality evidence for future decisions and therefore larger gains in population health.

The Cancer Drugs Fund was introduced in England in 2010-11 with a £50m (€58m; $65m) budget, which grew to £340m in 2015-16 without evidence of patient benefits.2 Since the reforms, the National Institute for Health and Care Excellence (NICE) is responsible for appraising all new cancer drugs, and the fund will pay for those drugs which have a chance of being judged cost effective, …

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