14 June 2016 - Throughout my career as a health economist, one issue has always been a mystery to me—why does cancer enjoy such a dominant position within healthcare systems throughout the world?

The debate concerning the reconfiguration of the Cancer Drugs Fund (CDF), which is addressed in this journal, represents a microcosm of a much wider debate reflecting the complex and ever-changing interface between political expediency and clinical rationality within health services internationally.

Within the UK National Health Service (NHS), the CDF has been the subject of controversy since its inception because it creates a ‘backdoor’ to healthcare funding that circumvents HTA programmes in the UK and is only available for cancer drugs. The existence of a more favourable funding mechanism solely dedicated to extending the use of cancer drugs (irrespective of their clinical and cost effectiveness) represents a major health policy issue as it introduces significant inequalities into a UK system that was founded on the premise of providing equal access to patients in equal need.

The very existence of the CDF is contrary to this founding principle as it creates a two-tier definition of ‘need’—one for cancer and one for patients from every other therapeutic area. Such a fundamental realignment of health service principles in favour of cancer patients inevitably imposes significant ethical, economic and health implications as a direct consequence of this inequity, which is now built into the funding basis of the NHS.

For more details, go to: http://link.springer.com/article/10.1007/s40273-016-0413-0?wt_mc=alerts.TOCjournals