Today’s headline is that the Cancer Drugs Fund, which was announced by the Tories in 2010 and ran until 2016, was a ‘huge waste of money’. The Annals of Oncology journal has published a study led by Professor Richard Sullivan of King’s College London, who also described the Fund as a ‘major policy error’.
The Conservatives thought they could pick up a few votes in 2010 by promising to fund expensive cancer drugs that the NHS was not funding, and the CDF was the result. It funded cancer patients to receive medications which had not yet been approved by the National Institute of Health and Care Excellence (NICE). Launched in 2011 with a budget of £200 million, the Fund was supposed to be a stopgap while alternatives were developed, and was initially scheduled to run until 2014. However, the government did not pursue its alternative policy, the ominous-sounding Value-Based Pricing, and instead extended the CDF until 2016, by which time it had been denounced by the Cancer Taskforce and the National Audit Office as unsustainable, and some doctors - including Richard Sullivan - were calling it an ‘unethical fix’ and a ‘waste of public money’. Still the Conservatives promised in their 2015 election manifesto that ‘We will continue to invest in our lifesaving Cancer Drugs Fund’ and issued the poster pictured, only to scrap the CDF a year later, absorbing it into NICE.
The Tory-supporting Daily Telegraph is one of the media outlets today reporting the denunciation of the CDF, though it is careful to attribute it to the now-departed David Cameron personally rather than to the Conservative Party.
Around 100,000 patients received drugs under the CDF, but the study found that due to its failings, some patients were harmed by side effects (‘dying in agony’ according to the Telegraph), and only one in five patients received any benefit. However, that does mean that 20,000 benefited from the drugs they received. The study also tells us that of the drugs with some evidence of benefit, the average extension to life was 3.2 months. Not only is every day of that precious to cancer patients and their loved ones, but as this figure is the average, some patients have extended their lives by considerably longer. One of these has been Bonnie Cox, who has secondary breast cancer and has been speaking in public in defence of funding these treatments. Bonnie has been taking a combination of Herceptin and Perjeta, the second of which is not yet endorsed by NICE and therefore only available through the CDF. She says, ‘I feel absolutely fantastic on these drugs. They have enabled me to carry on my life relatively normally since my diagnosis in 2015’ (BBC TV interview, 28 April 2017). This combination of medications gives an average extra 16 months’ survival, which could make the difference between whether her son, currently two years old, remembers his mother. Her current drug regimen will continue, but the planned next stage of treatment is now in doubt, so while trying to live her remaining life to the full, Bonnie will now have to fight for the treatments that enable that to happen.
In its five-year lifespan, the CDF cost £1.27bn. Unhelpfully, the BBC lists ‘Five things £1.27bn can pay for in the NHS (over five years): 10,000 nurses; 2,500 hospital consultants; one of England’s 10 regional ambulance services; a one-off pay rise of 2.5% for every member of NHS staff; an extra 20 GP surgeries.’ Report author Prof Sullivan dislikes this approach, criticising it in a TV interview today as an attempt to trade off precious extra time for people with terminal cancer for other parts of the NHS. How far down this route will we go? Will we be working out how many tooth extractions would cost the same as a heart bypass operation? Or whether paying hospital cleaners a living wage would mean having to close a certain number of accident and emergency departments? The issue is not about robbing Petra to pay Paula, it is not about the buying of extra months of life being a waste of money, it is about funding treatments directly and effectively - which, according to this study, the CDF did not do. Sullivan says that he wants research, new medicines, and better outcomes. He wants the funding to be there, and supports patient access to expensive medicines. But he is critical of the way the CDF operated, accusing it of not following up patients in terms of outcomes, so that no lessons were learned from those who did not do so well.
The case for a fund like the CDF arises from the length of time that NICE takes to approve new drugs, and its habit of rejecting some beneficial ones on the grounds of cost. Perjeta was approved by NICE late last year, but only in combination with other drugs and for 'patients with HER2-positive, locally advanced, inflammatory, or early-stage breast cancer at high risk of recurrence’. It therefore remains unavailable to many women with terminal breast cancer through normal NHS routes. Moreover, having rejected it in 2013, NICE only approved Perjeta three years later when its manufacturer Roche agreed to apply a discount. Its normal price is £2,395 per 420‑mg vial (excluding VAT); the level of discount is ‘commercially sensitive’, even though it is a deal with the Department of Health, and therefore supposedly accountable to the public.
But the Department of Health was unable to reach a similar discount deal with the same manufacturer for the life-extending medicine Kadcyla, leaving women with terminal secondary breast cancer (such as Katrina Keyte) unable to use it to extend their lives because of the £90,000 price tag. In 2014, Breakthrough Breast Cancer described Kadcyla as ‘a brilliant drug’ but ‘incredibly expensive’, adding that ‘Prices set by the pharmaceutical industry for impressive, life-extending drugs such as Kadcyla must come down. It's impossible to put a price on life's precious moments. But it’s not impossible to put a fair price on drugs.’
When NICE refused to approve a drug, the only route to get it was through the Cancer Drugs Fund, which would pay the higher price. Four particular facts tell an important story about what the Tories’ CDF was about:
- Before the 2010 General Election and the subsequent launch of the Cancer Drugs Fund, Roche threatened to pull out of the UK because it was not being paid enough for its liking.
- Roche’s chief executive and lobbyists were heavily involved in designing the CDF.
- Roche was the greatest beneficiary of CDF spending (in 2014, around a quarter of all applications to the fund were for Roche’s Avastin alone).
- Roche made a core operating profit of £18 billion in 2016.
The Cancer Drugs Fund was a mechanism for channelling public money into private companies’ profits specifically when a public body had decided that the price tag was too high or when the drug was not even effective. The study reported today found that only 18% of drugs listed by the CDF met internationally recognised criteria for clinical benefit. The Fund was a facilitator for firms which marketed unproved products or over-priced good ones to be paid their over-the-top prices anyway.
Of course, if you are dying of cancer, you want the drugs, whatever the price. And of course, cancer charities will advocate for the provision of these drugs. If my cancer comes back and is more aggressive, even terminal, I will want to try drugs - even as-yet-unproved ones - and will be sickened if the NHS will not pay for it. The private companies are exploiting the desperation of the dying to up their profits, and through the CDF, the Tory government has been helping them to do so.
Today’s statement from Conservative Party praises the CDF, has a pop at Labour for not running an equivalent fund in Wales (in fact, these medications are available to patients in Wales on an individual application basis), and concludes with the mantra that NHS investment is reliant on a growing economy, which only the ‘strong and stable’ leadership of Theresa May can provide. The emerging truth about the Cancer Drugs Fund tells a different story. Moreover, the Conservative Party may claim to champion access to cancer treatments, but last year the government quietly ‘de-listed’ 25 cancer medications, a decision described by charities as ‘a dramatic step backwards’. What chance is there of new cancer medications under a Tory government when it is withdrawing existing ones?
Today’s headlines tell of a failed Tory policy, where a vote-grab was not backed up by proper resources or democratic accountability. That is bad enough. But looking behind the headlines, we can see something even more poisonous than the opportunism and incompetence that this suggests. It is the symbiotic relationship between the Conservative Party and big capital, in which cancer patients’ lives are just pawns in a profit-maximising game.
If the government stopped kowtowing to pharmaceutical companies and instead brought them into public ownership, then it could develop and provide life-saving and life-extending medications itself, far more fairly and efficiently than the Cancer Drugs Fund or any alternative arrangement that lines the same pockets through a different mechanism. Until then, we can at least vote the Tories out in six weeks' time.