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The National Institute for Health and Care Excellence (NICE) is responsible for appraising new drugs and deciding whether they are clinically and cost effective enough to be approved for NHS funding.
Due to the challenges with the NICE process for certain cancer types, the Cancer Drugs Fund (CDF) was created in April 2011 as an alternative funding avenue, enabling patients to access drugs that have not yet been recommended by NICE for routine use within NHS England. Since its inception, it has enabled over 80,000 patients to access treatments that would otherwise not have been routinely available to them.
In recent years, the CDF budget has been overspent and it is now widely acknowledged that this model of the fund is financially unsustainable. With the CDF in its current form due to end in March 2016, NHS England recently proposed significant changes to the operation of the CDF to improve its financial sustainability.
Under the proposed new model, NICE will assess all new cancer drugs. New drugs will either receive a positive recommendation (for routine use within the NHS), a negative recommendation (not recommended for use within the NHS) or a 'maybe' (recommended for use within the CDF whilst more evidence is collected). In essence, the CDF will now provide interim funding for new drugs whilst decisions are being made by NICE as to whether the treatment should be accepted for routine use in the NHS in the future.
The public, as well as organisations like Leukaemia CARE, have been given the opportunity to comment on the proposals for the new model of the Cancer Drugs Fund so that an informed decision can be made regarding the future of funding life-saving cancer treatments. Leukaemia CARE has independently responded to the CDF proposal, as well provided input for responses in collaboration with patient advocacy groups Cancer 52 and the Blood Cancer Alliance.
For more information on the new model, the proposals are available here.
Zack Pemberton-Whiteley, Head of Campaigns and Advocacy at Leukaemia CARE said:
“The creation of the Cancer Drugs Fund in 2011 was intended to be a temporary solution, enabling access to cancer drugs whilst a long-term solution was found for the inherent issues in the NICE appraisal process. Whilst the CDF in its current form is not a sustainable solution, it has offered improved access to treatment for thousands of cancer patients and it is imperative that this access is retained within any proposed new model.
"It is clear that some elements of the proposed new model should be positively received. In principle, the proposals offer an opportunity for accelerated access to cancer drugs for NHS patients. They also propose to provide interim funding to enable the collection of ‘real world evidence’ to inform NICE’s decisions as to whether a drug should be recommended for routine use. However, whilst some areas of the proposed new model are agreeable in principle, there are two prominent issues that need addressing.
"Firstly, the consultation does not contain sufficient detail to explain how the proposals will translate into a functioning system in practice. For example, at present there is very little information on how patients will be involved within the proposed new model, who will have the responsibility of collecting this ‘real world evidence’ and how the criteria for entry to the fund will be applied. It is hard to understand why this consultation has been published without any of this information, unless these details are still to be developed. This would be extremely concerning with any new model due to be in place by the 1st of April.
"The second, more fundamental issue with the proposed model is that it does not address the challenges with the NICE process that led to the creation of the CDF in the first place. It is widely acknowledged that the NICE model has inherent issues coping with uncertainty. For certain cancer types (such as rarer or chronic cancers), this uncertainty is due to the challenges of data collection in these groups. In many cases, no amount of data collection will ever be able to address this uncertainty (and especially not in a two year period).
''So whilst this earlier or interim access to cancer drugs may be welcome, unless significant amendments are to be made to the NICE process to allow for this uncertainty, we will continue to see NICE routinely turning down clinically effective medicines for rarer and chronic cancers – including many types of blood cancer. Under the proposed model, once NICE has turned down a drug there will be no alternative method of access for patients (equivalent to the current version of the CDF).
"Unfortunately, the proposed model appears to focusing on ensuring the rigorous assessment of new cancer drugs, rather than seeking to ensure that the most clinically effective options are available to the patients who need them.”
You can access our full response here.
Alternatively, if you have any questions regarding the consultation, email the Campaigns and Advocacy team at firstname.lastname@example.org or call 01905 755 977.