BACKGOUND: The Cancer Drugs Fund (CDF) has been the subject of controversy since its inception, with critics arguing that it creates a "backdoor" to the National Health Service (NHS), circumventing the National Institute for Health and Care Excellence and its health technology assessment program. Nonetheless, with its creation comes a new decision problem, how to best allocate resources among cancer drugs. OBJECTIVES: Our objective was to estimate CDF's willingness and ability to pay for cancer drugs, providing guidance regarding where CDF funds are best spent, and determining the number of NHS quality-adjusted life-years (QALYs) displaced through the existence of the fund. METHODS: Using CDF utilization figures, cost-per-QALY, and treatment episode costs from National Institute for Health and Care Excellence health technology assessment reports, the league-table approach was applied to determine appropriate cost-effectiveness thresholds to inform the CDF's decision making. RESULTS: The CDF exhibits a willingness-to-pay value of £223,627 per QALY, with 74% and 33% of expenditure for drugs with incremental cost-effectiveness ratios of more than £50,000 and more than £90,000, respectively. During 2013-2014, CDF expenditure generated 4,677 QALYs, compared with a potential 13,485 if the same funds were used as part of routine NHS commissioning, displacing 8,808 QALYs. By ring fencing 10%, 25%, and 50% of the CDF budget for the provision of unevaluated drugs, cost-effectiveness thresholds of £149,000, £111,400, and £68,600 were calculated, respectively. CONCLUSIONS: Adopting the proposed framework for CDF prioritization would result in disinvestment from a number of highly cost-ineffective drugs applicable for CDF reimbursement. The present lack of a formal economic evaluation not only results in net health losses but also compromises a founding principle of the NHS, that of "equal access for equal need."
BACKGOUND: The Cancer Drugs Fund (CDF) has been the subject of controversy since its inception, with critics arguing that it creates a "backdoor" to the National Health Service (NHS), circumventing the National Institute for Health and Care Excellence and its health technology assessment program. Nonetheless, with its creation comes a new decision problem, how to best allocate resources among cancer drugs. OBJECTIVES: Our objective was to estimate CDF's willingness and ability to pay for cancer drugs, providing guidance regarding where CDF funds are best spent, and determining the number of NHS quality-adjusted life-years (QALYs) displaced through the existence of the fund. METHODS: Using CDF utilization figures, cost-per-QALY, and treatment episode costs from National Institute for Health and Care Excellence health technology assessment reports, the league-table approach was applied to determine appropriate cost-effectiveness thresholds to inform the CDF's decision making. RESULTS: The CDF exhibits a willingness-to-pay value of £223,627 per QALY, with 74% and 33% of expenditure for drugs with incremental cost-effectiveness ratios of more than £50,000 and more than £90,000, respectively. During 2013-2014, CDF expenditure generated 4,677 QALYs, compared with a potential 13,485 if the same funds were used as part of routine NHS commissioning, displacing 8,808 QALYs. By ring fencing 10%, 25%, and 50% of the CDF budget for the provision of unevaluated drugs, cost-effectiveness thresholds of £149,000, £111,400, and £68,600 were calculated, respectively. CONCLUSIONS: Adopting the proposed framework for CDF prioritization would result in disinvestment from a number of highly cost-ineffective drugs applicable for CDF reimbursement. The present lack of a formal economic evaluation not only results in net health losses but also compromises a founding principle of the NHS, that of "equal access for equal need."