Did It Matter That the Cancer Drugs Fund Was Not NICE? A Retrospective Review

Abstract

General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms October 2010 and the introduction of reforms to its structure and operations in July 2016. There has been much more debate about the existence of the fund than about how it spent its substantial budget. It is important to undertake a retrospective examination of "where the money went" in light of the substantial reforms that will be introduced in 2016.Objective: We review the means by which the CDF made recent funding decisions for cancer drugs in order to provide an assessment of the merits of the CDF "model" as a basis for allocation decisions. We assess the extent to which proposed reforms could overcome defects in the original CDF model of prioritisation, and lessons for other countries. Methods:We provide a narrative commentary on the CDF's methods and processes since 2014. We evaluate methods against best practice in cost-effectiveness analysis, and processes against the "accountability for reasonableness" framework.We comment on reforms to the fund.Results: There are no grounds for concluding that the opportunity costs imposed on cancer patients were well evidenced, or the product of legitimate deliberative processes. We note that some of these issues will be addressed in the proposed next incarnation of the fund, but the rationale for the fund's existence remains unconvincing.

Will the reformed Cancer Drugs Fund address the most common types of uncertainty? An analysis of NICE cancer drug appraisals

“…There has been extensive debate about the CDF’s justification [ 3 , 4 ] sustainability [ 2 ] and decision processes [ 5 ], and in 2016 it underwent reform, under which all funding decisions were re-integrated into NICE. In addition to providing interim funding for newly approved cancer drugs, the reformed CDF functions as a managed access fund.…”

Do patient access schemes for high-cost cancer drugs deliver value to society?—lessons from the NHS Cancer Drugs Fund

“…In this respect, the criteria and value judgements initially used by the CDF has been criticized for its lack of rigour and relevance for prioritizing drugs for reimbursement through the fund [ 78 ]. The tabulation also underscores the fluid nature of the CDF and raises questions as to whether approvals were occurring too quickly or are being driven by factors other than academic/scientific considerations.…”

Improving Patient Access to New Drugs in South Korea: Evaluation of the National Drug Formulary System

“…Countries such as the UK and Australia have separate cancer drug funds to provide patients with access to drugs that have clinically plausible potential with additional data but have not yet been appraised [20,21,22,23]. The funds improve patients’ access to new innovative drugs to treat rare diseases or cancers that satisfy specific criteria while adhering to the rules of the health insurance system.…”

“…Countries such as Australia, Great Britain, and Canada have separate organizations or expedited assessment pathways for costly anticancer drugs during the technology assessment and reimbursement decision-making processes [16,17,18,19]. Furthermore, many countries (e.g., Australia, Belgium, Italy, and Great Britain) also possess various drug funds for rare diseases or anticancer drugs to improve patient access to novel drugs [20,21,22,23]. Despite these efforts, many countries have failed to provide possible alternatives for a more comprehensive assessment method that can satisfy all concerned parties.…”