Three national bodies in the UK conduct Health Technology Assessments (HTA) to evaluate medical technologies: NICE in England, SMC in Scotland, and AWMSG in Wales. The study analyzed 86 SMC assessments from 2012-2013, of which 56 were not reviewed by NICE. Of these, 27 local assessments in England were published after SMC assessments. The study found about half of local assessments were consistent with SMC, while half differed, indicating local groups make independent decisions and SMC does not significantly influence local recommendations in England.

1. Health Technology Assessments (HTA) are multidisciplinary evaluations of the social,
economic, organisational and ethical issues of a drug, medical device or surgical and
clinical procedure. Their role is to help the relevant decision-makers with regard to
the appropriate use of a technology and the efficient allocation of resources.1
Three national bodies in the UK have been charged with carrying out HTA
assessments: NICE (National Institute for Health and Clinical Excellence), SMC
(Scottish Medicines Consortium) and AWMSG (All Wales Medicines Strategy
Group). Each of these produce reports and guidance on specific health technologies
and review the cost implications for each respective region in the United Kingdom –
NICE in England, SMC in Scotland and AWMSG in Wales.
Unlike the SMC, NICE does not evaluate all new medicines as they reach the
market, but selected medicines according to specific criteria relating to the expected
impact on clinical practice and budgets.2
The role of the SMC is to assess the status
of all newly licensed medicines, all new formulations of existing medicines and any
new indications for products already assessed. SMC assessments are used to
advise the Health Boards and their Area Drug and Therapeutics Committees on
the medicines used in NHS Scotland.2
For medicines not assessed by NICE but assessed by SMC, it was believed that the
SMC advice would influence subsequent recommendations on the funding and use
of medicines in England.
Besides the three HTA agencies, certain Medicines Management Groups (MMGs)
perform drug assessments on behalf of Clinical Commissioning Groups (CCGs) in
England. CCGs are bodies overseen by NHS England that have a decision-making
role in terms of what services are needed in a particular area and ensuring these are
implemented.3,4
MMGs, such as the Greater Manchester Medicines Management
Group (GMMMG), conduct their own medicine assessments by a committee of
clinicians and experts looking at the safety, clinical effectiveness, cost-effectiveness
and patient preference parameters.5
These reports will influence whether a medicine
is included in their local CCGs’ formularies or not.3
The present analysis will examine the relationship between the assessments done
by SMC, NICE and the individual MMG conclusions in order to assess whether there
is a correlation in their decisions.
It is often assumed that for medicines not assessed by NICE, the assessment by
the SMC influences subsequent local recommendations on the funding and use of
medicines in England. This research tests that hypothesis.
Background
▪▪ An analysis of SMC medicine assessments was carried out, comparing them to
NICE assessments within the same time frame.
▪▪ As seen in Table 1, the research was based on 86 medicine assessments carried
out by the SMC in 2012 and 2013, of which 56 were not reviewed by NICE.
The time period between 2012-2013 was deemed to be best for this analysis as
it represents assessments that could have been carried out by both SMC and
NICE, while 2014 was deemed too recent and could result in only one of the two
governmental bodies having carried out an assessment.
▪▪ Five MMGs advising CCGs whose assessments were readily available were
identified and are listed in Table 2. Their medicine assessments databases
were searched for the drugs that were reviewed by SMC but not NICE. Through
this we were able to find that 53 of the 56 drugs not reviewed by NICE had been
reviewed by the MMGs. However, only 27 of these assessments were published
after the SMC assessment. These 27 assessments were then compared for
similar outcomes with the respective SMC assessments. Differences and
similarities between the assessments, in terms of outcomes being either
positive, negative or restricted use, were noted.
▪▪ The comparison of assessments carried out by all 5 MMGs with SMC was
evaluated when drafting the final conclusion.
▪▪ As seen in figure 1, only around half (51%) of local assessments in England
were published subsequent to SMC assessments, so only this portion could
potentially have been influenced. Of these recommendations, which can be
seen in figure 1, 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, although not subjected to a full appraisal, were recommended by NICE
on the basis of evidence summaries or in clinical guidelines. This advice, although
not mandatory, can be expected to be influential and appears from our sample to
have been followed.
▪▪ Also, some medicines not recommended by SMC were subject to specialised
commissioning and the responsibility of NHS England rather than
local commissioners.
Overall results
▪▪ While a few assessments’ outcomes published by C&PCCG and MTRAC
(seen in figure 2 and 3, respectively) were consistent with SMC assessments,
the number was too low to be considered as significant for proof of SMC
influence on these CCGs.
▪▪ As seen in figure 4, the LCNDG assessments have no correlation with SMC
assessments, as the only assessment that was available for comparison with
the SMC differed in outcome.
▪▪ Compared to the other four CCGs sampled, GMMMG (as seen in figure 5) was
found to have assessed the most drugs previously evaluated by the SMC.
However, the GMMG also had a large number of assessment outcomes which
differed from those of the SMC. Therefore, there is no clear influence on the
GMMG from the SMC.
Table 1
Table 2
Methods
Results
Conclusions
Objective
▪▪ 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 consistent), but there are also significant differences.
It appears that English advisory bodies make their decisions independently of SMC recommendations, and often earlier.
▪▪ The main limitations of this study were time constraints, which did not allow us to analyse all MMGs and CCGs, and limited access to some MMG and CCG assessments.
▪▪ Further work would require analysis of a greater time range and a broader scope of MMGs and CCGs.
For additional information, please contact: cornelia.roibu@gfk.com © GfK 2015
Reviewed by SMC Total Not reviewed by NICE
2012 41 27
2013 45 29
Total 86 56
Local assessment groups Official website
London Cancer New Drugs Group (LCNDG)
www.medicinesresources.nhs.uk/en/
Communities/NHS/LCNDG/
Greater Manchester Medicines Management
Group (GMMMG)
http://gmmmg.nhs.uk/
Midlands Therapeutics Review and
Advisory Committee (MTRAC)
http://centreformedicinesoptimisation.co.uk/
mtrac
North East Treatment Advisory Group
(NETAG)
www.netag.nhs.uk/
Cambridge and Peterborough CCG
www.cambridgeshireandpeterboroughccg.nhs.
uk/CATCH/medicines-management.htm
4%
4%
*Excluded assessments were dated
prior to the SMC assessments
Figure 3: MTRAC assessments subsequent to
SMC assessment with relative outcome
92% 8%
Assessment not found
or excluded
Local assessment differs
from SMC
Portion of assessments with the
same outcome from both the
SMC and CCG
SMC assessment restricted and
local assessment consistent
SMC assessment negative and
local assessment consistent
SMC assessment positive and
local assessment consistent
*Excluded assessments were dated
prior to the SMC assessments
Assessment not found
or excluded
Local assessment differs
from SMC
Portion of assessments with the
same outcome from both the
SMC and CCG
SMC assessment restricted and
local assessment consistent
SMC assessment negative and
local assessment consistent
SMC assessment positive and
local assessment consistent
Figure 4: LCNDG assessments subsequent to SMC
assessment with relative outcome
98%
2%
6%
6%
13%
Figure 5: GMMG assessments subsequent to
SMC assessment with relative outcome
62%
13%
25%
*Excluded assessments were dated
prior to the SMC assessments
Assessment not found
or excluded
Local assessment differs
from SMC
Portion of assessments with the
same outcome from both the
SMC and CCG
SMC assessment restricted and
local assessment consistent
SMC assessment negative and
local assessment consistent
SMC assessment positive and
local assessment consistent
49%
17%
10%
15%
9%
34%
Assessment not found
or excluded
Local assessment differs
from SMC
Portion of assessments with the
same outcome from both the
SMC and CCG
SMC assessment restricted and
local assessment consistent
SMC assessment negative and
local assessment consistent
SMC assessment positive and
local assessment consistent
Figure 1: CCGs’ assessments subsequent to
SMC assessment with relative outcome
*All relevant NETAG assessments were published prior to SMC assessments; therefore, it was excluded from
final analysis. This chart includes data from C&PCCG, MTRAC, LNDG and GMMMG.
2%
Figure 2: C&PCCG assessments subsequent to
SMC assessment with relative outcome
96%
2%
2%
*Excluded assessments were dated
prior to the SMC assessments
Assessment not found
or excluded
Local assessment differs
from SMC
Portion of assessments with the
same outcome from both the
SMC and CCG
SMC assessment restricted and
local assessment consistent
SMC assessment negative and
local assessment consistent
SMC assessment positive and
local assessment consistent
Impact of assessments of new medicines by
the Scottish Medicines Consortium in England
Roibu C, Panciera D (GfK, London, UK); Furniss J (GfK, Melton Mowbray, UK)
1. WHO Health Technology Assessment. Available at: www.who.int/medical_devices/assessment/en/. Accessed September 1, 2015.
2. Taylor and Taylor, 2009. What is health technology assessment? Available at: www.medicine.ox.ac.uk/bandolier/painres/download/
whatis/What_is_health_tech.pdf. Accessed September 1, 2015.
3. Birmingham South Central Clinical Commissioning Group. http://bhamsouthcentralccg.nhs.uk/mm.
4. The King’s Fund. The new NHS: clinical commissioning groups. Available at: www.kingsfund.org.uk/projects/new-nhs/clinical-
commissioning-groups. Accessed September 1, 2015.
5. London Cancer New Drugs Group (LCNDG) – www.medicinesresources.nhs.uk/en/Communities/NHS/LCNDG/.
6. Greater Manchester Medicines Management Group (GMMMG) – http://gmmmg.nhs.uk/.
7. Midlands Therapeutics Review and Advisory Committee (MTRAC) – http://centreformedicinesoptimisation.co.uk/mtrac.
8. North East Treatment Advisory Group (NETAG) – www.netag.nhs.uk/.
9. Cambridge and Peterborough CCG (C&PCCG) – www.cambridgeshireandpeterboroughccg.nhs.uk/CATCH/medicines-management.htm.