COMMENTARY Cancer Drugs Fund 2.0: A Missed Opportunity? Christopher McCabe 1 • Ash Paul 2 • Greg Fell 3 • Mike Paulden 1 Ó Springer International Publishing Switzerland 2016 1 Introduction The UK National Health service (NHS), like most other developed health care systems, has struggled with how to address the financial challenge created by the steady stream of increasingly expensive cancer treatments receiving regulatory approval. In the first decade of this century, the UK National Institute for Health and Care Excellence (NICE) Technology Appraisal process was used to identify those that were likely to represent good value at the man- ufacturer’s asking price, to negotiate price discounts where possible, and to explain withholding of funding when negotiations failed. During the 2010 election campaign, the future Prime Minister, David Cameron, promised to create a Cancer Drugs Fund (CDF) to pay for those drugs for which NICE gave a negative recommendation. Once in power, his government described the CDF as an interim arrangement until value-based pricing (VBP) was intro- duced, towards the end of their first parliament. Whilst initially underspent, in the last 2 years of the parliament, the cost of the CDF increased by £241 million and the budget was overspent by 35 % [1]. By this time it had become clear that VBP was not going to be implemented [2] and the problem of costly cancer drugs remained a significant problem without a long-term sustainable solu- tion [1]. In November 2015, the UK Department of Health pro- posed a completely new CDF [3]. The new CDF will be based within NICE and use the same technology appraisal methods that NICE has implemented successfully for over 15 years. Reading the consultation document it appears that the new fund has been defined to achieve three things: (a) increase the likelihood that promising new cancer drugs will be provided to NHS patients; (b) generate ‘real world’ evidence on cancer drugs’ effectiveness and cost effec- tiveness; and (c) operate within its allocated budget. Whilst the proposed revised framework is a substantial improve- ment on the original CDF, its very existence remains problematic. The £340 million annual budget represents over 26,000 years of life in good health sacrificed at the altar of onco-exceptionalism [4]. NICE, which was estab- lished to put an end to the post code lottery in access to care, is now charged with implementing a new lottery, based upon diagnostic rather than post code. In addition, the potential of NICE to promote the development of truly valuable new technologies by signalling a clear willingness to pay for improvements in health is blunted, reducing its ability to contribute to more efficient health care for future patients. Despite this, it is unlikely that the political com- mitment to onco-exceptionalism will be reversed, and therefore, it is worth considering whether there are ways in which the new CDF could achieve its objectives more efficiently and effectively than by the processes outlined in the consultation document. We briefly summarize the key features of the revised CDF below, before explaining how the revised scheme will continue to damage the health of UK citizens. We then describe how, with some simple amendments to the & Christopher McCabe mccabe1@ualberta.ca 1 Department of Emergency Medicine, University of Alberta, Suite 736 University Terrace, 8303 112 Street, Edmonton, AB T6G 1K4, Canada 2 London Borough of Wandsworth, London, UK 3 Sheffield City Council, Room 209, Town Hall, Sheffield S1 2HH, UK PharmacoEconomics DOI 10.1007/s40273-016-0403-2