For UK Cancer Drug Fund, Does Cost Really Outweigh Clinical Efficacy in Their Decision-making Process?

Since our previous blog on the UK’s Cancer Drug Fund (CDF), there have been substantial changes to the CDF review process. In November of last year, the CDF decided to add cost to their evaluation criteria in response to the rising cost of cancer treatments and because of the $30.5 million overspend of the fund last year. The CDF also announced that it would re-evaluate 44 drugs in order to determine if these drugs would retain their CDF funding.

The addition of cost as an evaluation criterion and the re-evaluation of drugs already on the CDF priority list has been a contentious topic within the oncology market access world. The pharmaceutical industry and cancer advocacy groups are fearful that cost will be the major factor in CDF decisions and will further restrict the number of treatment options that are available to patients. Others applaud the change, viewing it as preventing the use of overpriced drugs in the UK.  

Are the manufacturers’ and cancer advocacy groups’ fears warranted? Does cost really outweigh the clinical efficacy of the drug in the CDF decision-making process? 

We analyzed the driving factors of positive CDF evaluations that did not consider cost (i.e. CDF decisions April 2013- July 2014) and that did consider cost (recent decisions from January 2015) to determine the influence of cost on CDF decision-making. The data included 82 CDF decisions published from April 2013- July 2014 and 56 decisions published in January 2015. Two independent logistical regression models were used to estimate the probability of a positive decision based on the scores of the individual CDF evaluated parameters (e.g., OS, PFS, cost, etc). We also examined the characteristics of the 17 drugs that retained CDF funding and the 27 drugs that were removed from the CDF priority list.  

Within the model, cost, overall survival (OS) and progression-free survival (PFS) were significant predictors of a positive CDF decision. We found that even when the cost of treatment is taken into account, a drug’s performance on OS and PFS are important. For example, even when controlling for cost, a drug had a 35% chance of obtaining a positive decision if it demonstrated an improvement of 2-3 months in OS and increased to 90% if the drug demonstrated an improvement of 6-7 months. 

When we compared the drugs that remained on the CDF priority list to those that were removed, we saw that regardless of cost, drugs that demonstrated greater improvement in OS and PFS were more likely to retain their funding.  

In the new CDF process, cost is important, but it is not the only influential parameter leading to positive decisions. The efficacy of the drug is still influential. Now that the CDF is taking into account efficacy and cost, how is their system different from NICE’s evaluation process?  

Does England need two similar systems for evaluating oncology therapies?