OBJECTIVES: To facilitate earlier patient access, the Cancer Drugs Fund (CDF) provides interim funding for promising new cancer treatments while additional evidence is collected to address any remaining uncertainty. At the end of the managed access period, new evidence is reviewed by the National Institute for Health and Care Excellence (NICE), and treatments may be recommended for routine funding. In 2022, NICE updated their methods and replaced the end-of-life (EOL) criteria with a new disease severity modifier (DSM). The objective of this study was to summarize outcomes from CDF reappraisals and describe when decision modifiers were used and whether their use was accepted by NICE.

METHODS: All technology appraisals (TAs) that entered and exited the CDF since it was reformed in 2016 until 20 June 2024 were identified. NICE recommendations and outcomes, such as incremental cost-effectiveness ratios (ICERs) and information about EOL or DSM criteria were extracted.

RESULTS: A total of 33 treatments exited the CDF during this period. Overall, 29 (88%) treatments were recommended for routine commissioning. Recommendations in 13 (39%) appraisals included only a subgroup of the full marketing authorization. Of the four (12%) treatments that were not recommended, two were not recommended following non-submission by the company. The EOL criteria were applied in 15 (45%) TAs, including in two CDF reviews reporting after the 1st February 2022 introduction of the DSM. No reappraisals successfully argued for a DSM of 1.2 or 1.7, although it was assessed in one.

CONCLUSIONS: There continues to be a high success rate for treatments exiting the CDF into routine commissioning. Where EOL was historically applied, treatments benefited from a higher cost-effectiveness threshold. It is uncertain whether the move from EOL to DSM will impact the proportion of treatments exiting the CDF in the future.