Cancer fund failure highlights the dilemma of drug pricing (Anjana Ahuja)
The challenge is to keep treatments affordable but still encourage innovation
The Cancer Drugs Fund was a trophy for politicians, a bottomless trough for public money and, worst of all, a tragedy for patients. The fund was set up in 2010 by the UK government as a way of expediting access to high-cost medicines for patients who did not have time on their side. It was supposed to cost £50m a year but ended up swallowing £1.3bn over six years.
In the measured language of an analysis published last week, the fund “failed to deliver meaningful value to patients or society” before it closed in 2016. Two years earlier, the CDF, designed to placate patient advocacy groups, was described by this newspaper as a “costly mistake”. Anyone who had oversight of the fund, from the National Audit Office to the influential parliamentary public accounts committee, condemned it as unsustainable. What happened is better characterised as a scandal.
The selling point of the CDF, which has since been radically reformed, was that it offered access to drugs that had either failed or not yet completed cost-benefit analysis by the National Institute for Health and Care Excellence. According to the paper published in the Annals of Oncology, only 18 of 47 available treatments offered any survival benefit. Some patients may have suffered toxic side-effects. The ringfenced fund, which elevated the financing of drugs above other factors that influence survival such as diagnostics and surgery, turned out to be a straitjacket, locking clinicians into paying inflated prices for therapies of dubious benefit.
The postmortem is essential reading for high-income countries grappling with the growing dilemma of drug pricing. Namely, how do governments settle on prices that are low enough to avoid bankrupting the economy but sufficiently high to encourage innovation?
The lead authors, at the London School of Hygiene and Tropical Medicine and Columbia University in New York, conclude that untouchable pots of money are unwise because they remove the imperative for drug companies to lower prices. Decisions should instead be made by bodies such as Nice, which operate without political interference, “to ensure decisions maximise value for cancer patients and society as a whole”.
Nice has threatened to stop recommending certain drugs unless companies slash prices, a tactic it deployed successfully with AstraZeneca’s ovarian cancer drug Olaparib. Its bargaining power derives from its ability to make decisions on behalf of the National Health Service. The reformed CDF came under Nice’s wings last year.
The challenge is this: the NHS, which offers free taxpayer-funded healthcare, must control costs at a time when the pharmaceutical sector looks vibrant. The UK, home to GlaxoSmithKline and AstraZeneca as well as a host of biotech start-ups, is in the curious position of having a pipeline of new cancer medicines feeding into a healthcare system that can barely afford them. This demands creative thinking, perhaps reimbursement contingent on outcome, or revamped post-licensing assessment regimes that mean drugs spend less time snarled up in regulatory limbo.
Otherwise, says Kapil Dhingra, an associate editor of the Annals of Oncology and former Roche executive, the UK risks becoming a nation of guinea pigs, with patients receiving treatments only in a clinical trial but not after licensing because of the sky-high costs. “That’s the kind of thing that used to happen in developing countries like India,” he said at a briefing in London last week.
Britain’s possible departure from the European Medicines Agency, which grants EU-wide marketing authorisation for new drugs, might also hamper timely access to novel therapies. Dr Dhingra said some companies might even shun the UK market, as a tiny slice of the increasingly affluent Indian and Chinese markets could offer more lucrative returns. This would be another avoidable tragedy in the making.
The writer is a science commentator