The Cancer Drugs Fund and variation in cancer drug prescribing: England versus Wales


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Charlotte Chamberlain1, Pete Stephens2, Kate Tilling1, William Hollingworth1
1University of Bristol, Bristol, UK, 2IMS Health, London, UK

Background

The establishment of the Cancer Drugs Fund (CDF) in October 2010 increased access to new high-cost cancer drugs for NHS patients in England. Patients elsewhere in the UK are not eligible for the Fund. The CDF is used to prescribe cancer drugs which have yet to be appraised by NICE, have been declined by NICE for poor cost-effectiveness, or are for uses outside their licensed indications. There has been little evaluation of trends in cancer drug prescribing in the UK countries since the introduction of the CDF.

Method

Intercontinental Medical Statistics (IMS) secondary-care prescribing data for high-cost cancer drugs has been compared across England and Wales from August 2007 to December 2012 using three-monthly moving averages per head of population. Two National Institute for Health and Care Excellence (NICE) recommended drugs (Paclitaxel, before the CDF period and Imatinib during) and two NICE-declined drugs (Bevacizumab and Lapatinib) are presented here to illustrate changes in prescribing variation in England and Wales over-time.

Results

Prescribing for Bevacizumab, the most commonly prescribed drug on the CDF, increased more rapidly in England (403.6%) than in Wales (145.1%) during the CDF period. Similarly, Lapatinib had increased prescribing of 469.5%, compared with 28.1% in Wales over the same period. Prescribing of Paclitaxel and Imatinib, did not markedly differ between England and Wales following the CDF (Paclitaxel: 23.3% increase in England, 29.9% in Wales, Imatinib: 8.1% increase in England, 21.4% in Wales).

Conclusion

The introduction of the CDF coincided with dramatic divergence of prescribing of NICE declined drugs (Bevacizumab, Lapatinib) between England and Wales, whereas drugs recommended by NICE saw similar prescribing trends. Further analysis, extending to a wider pool of drugs and using Poisson techniques interpreting the effect of NICE status on prescribing over time are underway.