An analysis in the trends in Scottish Medicines Committee (SMC) advice decisions for medicines for the period October 2009 to September 2015 has just been published in an OHE Consulting Report. This report was initiated and funded by Pfizer Ltd.
The report assesses trends during a period when the SMC were introducing a number of innovations in their methods and processes. These were:
- the increased use of modifiers when assessing cost-effectiveness,
- the introduction of Patient and Clinical Expert (PACE) groups, and
- the increased use of Patient Access Schemes (PAS)
Modifiers are instances where specific characteristics of a medicine, such as its use in patients with short life expectancy (end of life treatments) or small groups of patients (orphan medicines), are explicitly used in deliberations. PACE groups were introduced to recognise the importance of the views of patients and clinicians as decisions are being deliberated. PAS are commercial arrangements made between pharmaceutical companies and NHS Scotland, usually to offer a medicine at a reduced cost, with the intention to encourage SMC to recommend use.
We found that there has been an increase in medicines being accepted for use, with an associated decrease in decisions to not recommend use. Since October 2014, there has been an increase in the number of positive recommendations for cancer medicines at the same time there was an increase in the number of submissions using modifiers and PACE groups’ advice. In the first year of operation of PACE, SMC recommendations have not always been aligned with their deliberations. In the five instances where PACE made a strong recommendation for use of a medicine, but SMC did not recommend use, it appeared that the economic case outweighed the wider considerations presented by PACE groups (e.g. these medicines had high incremental cost-effectiveness ratios). The steady increase in PAS agreements and the upward trend in accepted decisions are dominant features of the period under consideration.
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