PHP191 - Impact of Assessments of New Medicines By The Smc In England

Abstract

The Scottish Medicines Consortium (SMC), unlike the National Institute for Health and Care Excellence in England, assesses all new medicines. It is often assumed that the assessment by the SMC influences subsequent local recommendations on the funding and use of medicines in England. This research tests that hypothesis. Research was based on 86 medicines assessed by the SMC in 2012 and 2013, of which 56 were not reviewed by NICE. A sample of five local assessment groups in England was identified. From these we found a total of 53 recommendations relating to medicines not reviewed by NICE, of which 27 were published subsequent to the SMC assessment. Only around half (51%) of local assessments in England were published subsequent to SMC assessments, so could potentially have been influenced. Of these recommendations two-thirds (18) were consistent with the SMC verdict, and one third (9) differed. Detailed analysis revealed additional factors. Several of the medicines in the sample were recommended by NICE on the basis of evidence summaries or in clinical guidelines. This advice, although not mandatory, appears from our sample to have been followed. Also some medicines not recommended by SMC were subject to specialised commissioning, the responsibility of NHS England rather than local commissioners. There is some consistency between assessments of new medicines in Scotland and England (as might be expected given that the evidence and decision criteria are broadly similar) but there are also significant differences. It appears English advisory bodies make their decisions independently of SMC recommendations, and often earlier. Other differences, such as NICE evidence summaries and Specialised Commissioning in England, further reduce the influence of Scottish decisions.