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Overspend means the Cancer Drugs Fund ‘no longer sustainable’ – NAO

The Cancer Drugs Fund, which provides access to drugs not routinely available on the NHS, is no longer sustainable in its current form due to the rocketing costs of treatment, the National Audit Office (NAO) has warned.

The auditor revealed that a rise in the average cost of treatment per patient, alongside the increasing numbers of patients supported, meant the fund could no longer be viably financed.

In July, NHS England suggested that the fund should become a ‘managed access’ fund that pays for new drugs for a set period before NICE decides whether they should become routinely available in the state service.

This would mean the fund would no longer support appraised drugs that are not specifically recommended by NICE.

NHS England intends to consult on these proposals in the autumn in a bid to implement new arrangements from April 2016.

Meg Hillier MP, chair of the committee of public accounts, said there needs to be “much better control of costs and proper assessment of whether these drugs are making a difference to the health of patients”.

But Baroness Delyth Morgan, chief executive at Breast Cancer Now, said it has been “clear for some time now that [the fund] no longer works”, with the report just confirming “what we already knew”.

She said: “The government, the NHS and the pharmaceutical industry have overpromised to those that depend on them, and by failing to agree on realistic prices of new drugs, the simple fact is that people will die sooner from breast and other cancers.

“The time for change is long overdue and we, like those who rely on the fund, are growing impatient to see the proposed plans to reform the [fund] expected any day now.”

Although the fund has improved access to promising cancer drugs overall, with over 74,000 patients receiving new drugs through it from October 2010 to March 2015, it has recently seen its drug list slashed as NHS England failed to manage overspending.

It removed access to some drugs in March for the first time after a review of clinical effectiveness and cost, while axing a further 16 medicines earlier this month.

The cost of the fund from October 2010 to March 2015 was £938m. Although this was slightly above the budget, it actually underspent its cash in the early years.

But taking 2013-14 and 2014-15 together shows NHS England overspent the allocated money by 35%, taking the cost of the fund up by 138% to £214m.

The fund was initially set up to run until March 2014 on a budget of £650m while a long-term pricing mechanism was worked out to give patients access to special treatments recommended by their doctors.

Yet the government decided to extend it in 2013 by another three years, upping its lifetime total budget to a total of £1.27bn.

The auditor also showed that over half of this rise was due to an increase in cost per patient, while the rest was linked to an increase of patients supported by the fund.

But NAO noted that, due to a lack of data, it is not currently possible to evaluate the fund’s impact on patient outcomes such as survival.

However a data sharing agreement between NHS England and Public Health England, signed in July, should begin to enable outcomes to be tracked.

Criticising the data gap, Hillier said: “Given the need to make informed choices about how to spend finite resources wisely, it makes no sense that the department and NHS England lack the data needed to assess the effectiveness of the Cancer Drugs Fund and whether it is the best way to care for patients.”