Skip to main content

The Cancer Drugs Fund in Practice and Under the New Framework



The Cancer Drugs Fund (CDF) was established in 2010 to improve access to treatments not routinely available. Having widely overspent, stricter budgeting rules were introduced in 2016. The CDF can now only include treatments with potential to be cost effective once sufficient data are collected.


Our objective was to explore the process and criteria used for consideration of treatments under the new CDF framework and to describe the extent of evidence collection.


We identified CDF list, UK National Institute for Health and Care Excellence (NICE) and Scottish Medicines Consortium documents (10 May 2018). Data were collected on drugs and indications, reasons for inclusion in the CDF, data collection, incremental cost-effectiveness ratios (ICERs), and corresponding recommendations for Scotland.


In total, 12 drugs were listed on the CDF in 17 indications, 12 of which were considered end-of-life care. The most common cancers were non-small-cell lung (n = 4), urothelial (n = 3), lymphocytic leukaemia (n = 2) and multiple myeloma (n = 2). The companies’ ICERs were generally lower than those from the committee and the evidence review group. Drugs were included in the CDF for 6–42 months, with the majority included for ≥18 months. Data were frequently collected on overall survival (n = 16) and progression-free survival (n = 5) using NHS systems and, frequently, ongoing trials.


Data collection frequently included overall survival and exceeded the 2 years recommended in the CDF strategy. It appears the CDF is allowing patients access to drugs long before they may become available for routine use. Our results are limited by the availability of published information and the small dataset.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. Brentuximab vedotin for treating cluster of differentiation (CD)-30-positive Hodgkin’s lymphoma marked as not currently available in the CDF had MAA and FAD documents present and was included in the analysis.


  1. International Agency for Research on Cancer, World Health Organisation. Globocan 2018: United Kingdom Factsheet. 2018. Accessed   5 Dec 2018.

  2. Cancer Research UK. Cancer in the UK 2018. 2018. Accessed   22 Aug 2018.

  3. Oke JL, O’Sullivan JW, Perera R, Nicholson BD. The mapping of cancer incidence and mortality trends in the UK from 1980–2013 reveals a potential for overdiagnosis. Sci Rep. 2018;8(1):14663.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): An analysis of population-based cancer registry data. Lancet. 2011;377(9760):127–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Davis C, Naci H, Gurpinar E, Poplavska E, Pinto A, Aggarwal A. Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009–13. BMJ. 2017;359.

  6. Rupp T, Zuckerman D. Quality of life, overall survival, and costs of cancer drugs approved based on surrogate endpoints. JAMA Internal Med. 2017;177(2):276–7.

    Article  Google Scholar 

  7. Cheema PK, Burkes RL. Overall survival should be the primary endpoint in clinical trials for advanced non-small-cell lung cancer. Curr Oncol (Toronto, Ont). 2013;20(2):e150–60.

    CAS  PubMed Central  Google Scholar 

  8. Workman P, Draetta GF, Schellens JHM, Bernards R. How much longer will we put up with $100,000 cancer drugs? Cell. 2017;168(4):579–83.

    Article  CAS  PubMed  Google Scholar 

  9. Light DW, Kantarjian H. Market spiral pricing of cancer drugs. Cancer. 2013;119(22):3900–2.

    Article  PubMed  Google Scholar 

  10. House of Commons Committee of Public Accounts. Cancer drugs fund twentieth report of session 2015-16. 2016. Accessed 22 Aug 2018.

  11. McCabe C, Paul A, Fell G, Paulden M. Cancer drugs fund 2.0: a missed opportunity? Pharmacoeconomics. 2016;34(7):629–33.

    Article  PubMed  Google Scholar 

  12. NHS England. Consultation on proposals for a new cancer drugs fund (CDF) operating model from April 2016. 2015. Accessed 22 Aug 2018.

  13. NHS England. Appraisal and funding of cancer drugs from July 2016 (including the new Cancer Drugs Fund) - A new deal for patients, taxpayers and industry. 2016. Accessed 23 Aug 2018.

  14. The Parliamentary Office of Science and Technology. Value based assessment of drugs. 2015. Accessed 17 Dec 2018.

  15. National Audit Office: Investigation into the Cancer Drugs Fund. 2015. Accessed 22 Aug 2018.

  16. NHS England. National Cancer Drugs Fund List ver 1.81. 2018. Accessed 10 May 2018.

  17. NICE. Guidance and advice list. 2018. Accessed 10 May 2018.

  18. SMC. Medicines advice. 2018. Accessed 10 May 2018.

  19. U.S. National Library of Medicine. database. 2018. Accessed 29 Nov 2018.

  20. NICE. Single Technology Appraisal - Venetoclax for treating chronic lymphocytic leukaemia [ID944]. 2017. Accessed 4 June 2018.

  21. NICE. Final appraisal determination - Pembrolizumab for untreated PD-L1-positive metastatic non-small-cell lung cancer. 2017. Accessed 31 May 2018.

  22. NICE. Final Appraisal Determination - Ibrutinib for treating Waldenstrom’s macroglobulinaemia. 2017. Accessed 23 May 2018.

  23. NICE. Final appraisal determination - Osimertinib for treating locally advanced or metastatic EGFR T790M mutation-positive non-small-cell lung cancer. 2016. Accessed 30 May 2018.

  24. NICE. Single Technology Appraisal - Avelumab for treating metastatic merkel cell carcinoma [ID1102]. 2017. Accessed 11 May 2018.

  25. NICE. Single Technology Appraisal - Ixazomib citrate for treating relapsed or refractory multiple myeloma [ID807]. 2017. Accessed 24 May 2018.

  26. NICE. Single Technology Appraisal - Olaratumab in combination with doxorubicin for treating advanced soft tissue sarcoma. 2017. Accessed 30 May 2018.

  27. NICE. Single Technology Appraisal - Osimertinib for treating metastatic EGFR and T790M mutation-positive non-small-cell lung cancer [ID874]. 2016. Accessed 30 May 2018.

  28. Grieve R, Abrams K, Claxton K, Goldacre B, James N, Nicholl J et al. Cancer Drugs Fund requires further reform: reliance on “real world” observational data undermines evidence base for clinical practice. BMJ. 2016;354(i5090).

  29. Dickson R, Boland A, Duarte R, Kotas E, Woolacott N, Hodgson R, et al. EMA and NICE appraisal processes for cancer drugs: current status and uncertainties. Appl Health Econ Health Pol. 2018;16(4):429–32.

    Article  Google Scholar 

  30. NICE. Guide to the processes of technology appraisal. 2014. Accessed 5 Dec 2018.

  31. NICE. Appraising life-extending, end of life treatments. 2009. Accessed 30 Nov 2018.

  32. Orphanet. The portal for rare diseases and orphan drugs. Accessed 10 Dec 2018.

  33. SMC. Process for end of life and very rare conditions (orphan and ultra-orphan medicines). 2016. Accessed 5 Mar 2018.

  34. National Institute for Health and Care Excellence. Guide to the methods of technology appraisal 2013. London: National Institute for Health and Care Excellence; 2013.

    Google Scholar 

  35. NICE. Single Technology Appraisal - Nivolumab for previously treated locally advanced or metastatic nonsquamous non-small-cell lung cancer [ID900]. 2017. Accessed 25 May 2018.

  36. NICE. Single Technology Appraisal - Nivolumab for previously treated locally advanced or metastatic squamous non-small-cell lung cancer. 2015. Accessed 25 June 2018.

  37. NICE. Single Technology Appraisal - Pembrolizumab for untreated PD-L1 positive metastatic non-small-cell lung cancer [ID990]. 2018. Accessed 31 May 2018.

  38. NICE. Single Technology Appraisal - Atezolizumab for treating metastatic urothelial bladder cancer after platinum based chemotherapy [ID939]. 2017. Accessed 17 May 2018.

  39. NICE. Single Technology Appraisal - Pembrolizumab for previously treated advanced or metastatic urothelial cancer. 2017. Accessed 31 May 2018.

  40. NICE. Single Technology Appraisal - Pembrolizumab for locally advanced or metastatic urothelial cancer where cisplatin is unsuitable [ID1209]. 2018. Accessed 1 June 2018.

  41. NICE. Single Technology Appraisal - Daratumumab monotherapy for treating relapsed and refractory multiple myeloma [ID933]. 2018. Accessed 22 May 2018.

  42. NICE. Single Technology Appraisal - Brentuximab vedotin for treating CD30-positive Hodgkin’s lymphoma. 2018. Accessed 18 May 2018.

  43. NICE. Single Technology Appraisal - Ibrutinib for treating Waldenstrom’s macroglobulinaemia [ID884]. 2017. Accessed 23 May 2018.

  44. NICE. Single Technology Appraisal - Nivolumab for treating recurrent or metastatic squamous-cell carcinoma of the head and neck after platinum-based chemotherapy. 2017. Accessed 29 May 2018.

  45. NICE. Single Technology Appraisal - Obinutuzumab for untreated advanced follicular lymphoma [ID1020]. 2018. Accessed 29 May 2018.

Download references


The authors thank Arianna Gentilini and Marta Giulia Viola for comments on the data synthesis.

Author information

Authors and Affiliations



CSG, KM and AD designed the study, CSG carried out and KM checked the accuracy of identification of relevant cases and data collection, CSG, KM and AD undertook the synthesis and interpretation of the data. CSG and KM drafted the manuscript and all authors approved the final version.

Corresponding author

Correspondence to Celia Sabry-Grant.

Ethics declarations


No sources of funding were used to conduct this study or prepare this manuscript.

Conflicts of interest

C. Sabry-Grant, K. Malottki and A. Diamantopoulos have no conflicts of interest that are directly relevant to the content of this article.

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sabry-Grant, C., Malottki, K. & Diamantopoulos, A. The Cancer Drugs Fund in Practice and Under the New Framework. PharmacoEconomics 37, 953–962 (2019).

Download citation

  • Published:

  • Issue Date:

  • DOI: