PCN242 - Evidence for Regional Variation in the Appraisal of Individual Cancer Drugs Fund Requests

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The Cancer Drugs Fund (CDF) was set up in 2011 in England to enable cancer patients to gain access to therapies that are not routinely available on the NHS. A national CDF cohort policy lists drugs to be funded for patients who meet the relevant clinical criteria. Individual Cancer Drug Fund requests (ICDFRs) can also be made for patients outside of routine cohort CDF criteria for rare diseases or, in cases where a decision has been made not to fund a cohort, for patients for whom clinical exceptionality from this cohort can be demonstrated. ICDFRs are screened to ensure that the request is appropriate and are then appraised by one of four regional CDF panels. This research aimed to evaluate whether access to oncologics through ICDFRs varies by region. ICDFR outcomes data (April 2013–March 2014) was extracted from the NHS website and stratified by NHS estimates of the resident population by region. All statistical analyses were performed using a Chi-squared test. 1029 ICDFR applications were received for consideration (London, 301; East and Midlands, 231; North England, 181; South England, 316), 46% of which were deemed ineligible by screening, significantly varying by region (p<0.0001, range 22% (North England) to 67% (East and Midlands) ). 50% of screened ICDFRs were approved, which varied substantially by region (p<0.0001, range 37% (East and Midlands) to 72% (South England) ). Overall, around 5.5 ICDFRs were accepted per million patients across England, however, between regions this ratio varied over six-fold (range 1.9 (East and Midlands) to 12.0 (South England) ). The notable variations in ICDFR screening, acceptance, and population level approval rates, which are larger than what we may expect based on regional variations in case mix, suggest that regional areas must further collaborate to ensure that patients have equitable access to the Cancer Drugs Fund.