Cancer drugs approved for routine use on the NHS
10th August 2017 – Three-quarters of treatments in the Cancer Drugs Fund are now approved for routine use on the NHS.
The National Institute for Health and Care Excellence (NICE) has announced that 75% of the treatments that have been available only on the old Cancer Drugs Fund (CDF) have now been appraised and received positive recommendation for routine use on the NHS.
The start of a revised cancer drug approval procedure
NICE had been asked to review 24 cancer drugs across 33 cancer indications on the CDF. Because of previous concerns about the old CDF, a consultation on making changes to it began in November 2015. The proposals called for a switch of the approval-making decisions to the NICE and for a transitional period of up to 2 years before a treatment could be taken off the list. This would allow time to gather evidence from patients being treated with new drugs to help decision making for routine funding. It was announced in February 2016 that a new funding body, with a fixed budget of £340 million a year, would replace the CDF. This took place in July 2016, and under the new system NICE is now responsible for appraising new cancer drugs and making approval decisions. A joint NHS England/NICE CDF Investment Group oversees its budget management.
NICE now has three choices when reviewing a drug: recommend a drug for routine commissioning, thereby allowing it to become available on the NHS in England, not to recommend it and to recommend it for use with the CDF. In the latter case, there has to be a potential for the medicine to satisfy the criteria for routine commissioning, but it still needs more investigation through data collection in the NHS or ongoing clinical trials.
In today's announcement, of the 24 cancer treatments appraised, 18 have been approved in either final or draft guidance for 24 indications and 5 drugs are still in the process of being appraised for 5 indications. The majority of these drugs are now available for routine use on the NHS, with one drug remaining on the CDF list under special arrangements that will see further data collected while it is funded at a discounted price.
NICE has recommended, in a draft guidance published today, that sorafenib (Nexavar) for liver cancer comes off the CDF and is routinely made available to some patients on the NHS. It is recommended for patients with advanced liver cancer and a certain degree of liver impairment – only if the company provides sorafenib within the agreed commercial access arrangement. Patients must be on the Grade A level of the Child-Pugh grading system that classifies how well the liver is working. It will cost £128 a day to provide the drug to each patient. There were about 5,600 new cases of liver cancer in the UK in 2014, with more than 5,000 deaths. The recommendation does not affect treatment with sorafenib that was started in the NHS before this guidance was published.