New Cancer Drugs Fund solves the wrong problem

I agree with the proposal from Grieve and colleagues to allocate money from the Cancer Drugs Fund to randomised studies in place of the collection of observational data, though for different reasons.1

The collection of observational data by the new fund may be helpful in some cases, but in the vast majority it will not tackle key uncertainties in the health economic models that determine whether a drug is accepted for use. These uncertainties relate to the long term outcomes, such as survival at five or 10 years. If observational data are collected from the time of a NICE decision (plus the time to enrol patients), they are unlikely to arrive before the patent on the drug expires or the drug is replaced by a more effective treatment.

This shows the main issue with the revised fund; it solves the wrong problem. At the point of NICE assessment we generally have very good information on how the drug will perform over the first couple of years, which is what the fund will collect. More data here have minimal value. What we often lack, however, is information on the comparative effectiveness of the drug (as pointed out by Grieve and colleagues) and the long term outcomes (which would be better collected in extension studies to the original clinical trials).

The revised fund may be a useful political sticking plaster to defer difficult decisions, but it will rarely aid decision making and, therefore, is unlikely to improve the health of the population. As implied by Grieve and colleagues, it should be regarded as a missed opportunity.