1. Drug appraisal organisations: A comparison of SMC and NICE John Ford, University of Aberdeen Norman Waugh, Warwick Evidence Pawana Sharma, University of Aberdeen Mark Sculpher, University of York Andrew Walker, University of Glasgow

2. Scottish Medicine Consortium (SMC) Established in 2001 All newly licensed medications Main submission from manufacturer

3. National Institute of Health and Clinical Excellence (NICE) Only medications referred from Department of Health Pre-2005 – Technology Assessment Reports (TAR) Post-2005 – Single technology appraisal (STA) – Multiple technology appraisal (MTA) Various controversies

5. Our study What is the difference in recommendations and timelines between NICE and SMC? Has the introduction of the STA system led to speedier guidance?

6. Methods Drug specific approach All medications until Aug 2010 included Time – from marketing authorisation (MA) to guidance publication Appraisal outcomes – As defined by SMC or NICE

7. Drug demographics 140 drugs included – 57 cancer related 415 by SMC alone – 45 cancer related 102 by NICE – 27 cancer related

8. Recommendations

10. Reason for differences in recommendation Occasionally NICE allows cost per QALY >£30,000 Timings of appraisals may differ Manufacturers’ submission may not be the same Longer appraisals

11. Timelines (all drugs)

12. Reasons for differences in timelines Consultation – Number of stakeholders – Size differences – Legal challenge? Transparency – Final report

13. Timelines (cancer drugs)

14. Reasons for differences in cancer drugs Evidence base may be uncertain Cost per QALY likely to be borderline

15. Discussion Trade-off between transparency, consultation and timeliness How many drug appraisal bodies does the UK need?

16. Conclusion Small difference in recommendations between SMC and NICE SMC is considerable speedier than NICE STA system has led to speedier decisions, but not for cancer drugs Increased time is probably due to consultation and transparency

17. Any questions?