Assessing Trends in SMC Advice Decisions (October 2009- September 2015)

The objective of this OHE Consulting Report was to outline trends in Scottish Medicines Committee (SMC) advice decisions for medicines for the period October 2009 to September 2015. This report was initiated and funded by Pfizer Ltd. It specifically considers whether there were changes in the trends due to the adoption of new policies by the SMC, namely the increased use of modifiers when assessing cost-effectiveness (e.g. whether a treatment is for end of life, or is an orphan drug), the introduction of Patient and Clinical Expert (PACE) groups, and the increased use of Patient Access Schemes (PAS). We find 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 group’s advice. In the first year of PACE, SMC recommendations were not always aligned with the patient groups’ 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.