We discuss changes to the Cancer Drugs Fund list in light of media reports that all of the six breast cancer drugs currently available would be removed.
You will have seen a lot of media coverage about NHS England removing drugs from the Cancer Drugs Fund (CDF) list. Some of the coverage, particularly from late last week, was incorrect and, in our opinion, irresponsible. It was widely reported on Thursday and Friday last week that all of the six breast cancer drugs currently available on the CDF would be removed. This is not true. So what has happened?
The good news
The good news is that three of the six breast cancer drugs available through the CDF will remain available to new patients. This means that the panel of clinicians and patient representatives have decided that these drugs provide sufficient clinical benefit for the fund to continue paying for them. In some cases, the company concerned may have needed to offer a discount to the NHS to allow their product to remain available through the CDF. At Breakthrough we are relieved that some of the very effective breast cancer drugs will remain available to those patients who so desperately need them.
The bad news
Unfortunately, this means that three of the six drugs for breast cancer have been removed from the CDF. This is obviously very disappointing for patients who could have benefitted from these drugs. It is important to reiterate at this point that no patients currently taking these drugs will have them taken away. All patients taking drugs currently available through the CDF will continue to take those drugs until they and their doctors agree that it is no longer appropriate.
Most of the drugs that have been removed from the CDF have been removed because the panel does not consider them to offer enough clinical benefit for the CDF to continue to pay for them. For some of the drugs this might be influenced by survival. For instance, a drug may provide an extension of life but this may be a small extension, perhaps of one or two months over existing treatments. Some of the drugs might have severe side effects which can also impact how much clinical benefit they have.
Benefit versus cost
Some of the drugs that are being removed may be considered to offer clinical benefit but not enough clinical benefit to justify the high prices that the companies concerned were charging. In these cases, pharmaceutical companies were offered the chance to discount their products to ensure that they remain on the CDF. We were heartened to learn that many pharmaceutical companies have been able to discount the prices of their products. We are however disappointed that it has taken the drastic threat of their products being removed from the CDF for pharmaceutical companies to offer drugs at prices that are affordable to the NHS.
You may have heard that some companies were not offered the chance to discount the price of their product. The reason for this is that the drug is not considered to offer enough clinical benefit for the fund to pay for it. This is not to say that patients cannot benefit from the drug – for some patients, these drugs will be very beneficial and it is clearly very disappointing for those patients that these drugs will no longer be paid for by the CDF. However, the NHS has been clear that it needs to get the most value out of the CDF and this is through paying for the most clinically effective drugs.
Why has this happened?
As many of you will be aware, the CDF is a special pot of money set aside by the Government to pay for new cancer treatments which the National Institute for Health and Care Excellence (NICE) has not been able to approve. However, over the past year, the CDF has not been operating within budget and, in order to bring it back within budget, the panel reassessed several drugs to ensure that the CDF is funding the most clinically effective drugs. This is also the first time that the CDF panel has taken cost into account when considering which drugs should be made available through the fund.
What happens next?
Today marks the line in the sand beyond which we absolutely must see commitment from this and the next government to overhaul drug appraisal processes and pricing. That’s why we have called on all political parties, the pharmaceutical industry, NICE, NHS leaders and the devolved administrations to come together with a shared determination to bring about change and develop a clear roadmap to reform. We reiterate that call in the strongest possible terms today.
Breast cancer drugs remaining in the CDF
Breast cancer drugs being removed from the CDF
- Everolimus (Afinitor)
- Eribulin (Halaven)
- Lapatinib (Tyverb)
Dr Sarah Rawlings is Breakthrough's Assistant Director of Policy and Information