SMC Evaluation Programme

Overview

• Context• Evaluation Programme

– Stakeholders– SMC advice

• Conclusions

Context

• SMC established October 2001• SMC first advice April 2002

Remit To provide advice to NHS boards and their ADTCs across Scotland about the status of all newly licensed medicines, all new formulations of existing medicines and new indications for established products

Assessment process

Proforma

Pharmacy assessment Team

Health Economics group

NDC SMC

Submitted by company

Critical Appraisal of submission

ScientificAdvisory

Committee

Company response

Patient group

Advice in context of

NHS Scotland

Evaluation Programme

1. Stakeholders

2. SMC advice

Programme Delivery

• Structure– Project Team – Management Group – Reference Group – SMC Executive Team

• Timescale– 2 year programme (April 06 - March 08)

Stakeholders

Stakeholders – methods 1Impact on ADTCs role and function

• 2000• 2002• 2003/4

+ +

• 2006/7Review ofPublic

information

• Workshop June 2007 ADTCs n~ 60

Stakeholders – methods 2Engagement with stakeholders

Pharmaceutical Industry Workshop (n~100)

Public Partners*Postal questionnaires and interviews (n=154)

+ +ADTCs Workshop

(n~60)

* ScotCen – Scottish Centre for Social Research

Stakeholders - Key FindingsImpact on ADTCs’ role and function

Theme

Medicines Reviewed

Structures and processes

Implementation / Communication

Evaluation and monitoring

Evidence of consistency

2000

Variable: 3-91 per annum

Move from Trust to ADTCs Variation in discipline membership and skill set

Variable from clinician feedback to formulary inclusion

Challenging due to resources available

Variation in decisions made by NHS Boards

2006/7

All SMC advice

Continual evolving structures Variable discipline membership

Formulary management well established (move from lists to pathways) . More use of IT

Using available local and national data were possible. Little evaluation of impact of changing processes

Clarity of handling of SMC ‘not recommended’ adviceLocal decision systems for handling accepted /restricted SMC advice

Key FindingsEngagement with Stakeholders

ADTCs Public Partners Pharmaceutical Industry

Successes of engagement with SMC

Single source of timely advice

Reduction in ADTC evaluation of primary evidence

Quite successful where understood by groups

Robust, transparent processes

Industry recognised as partner

Challenges of engagement with SMC

Non submission to SMC Clarity for media and

patients of the role of local formularies

Limited awareness at time of survey of SMC (41%), its website and processes (33%)

Variation in how NHS boards implement advice

Lack of awareness of how companies contact industry reps on SMC

Improving engagement with SMC

Succession planning for SMC members

Evaluation of selected medicines licensed before SMC

E-mail to inform groups of relevant medicines

Inviting groups to attend SMC

Earlier access to economic checklist

Collaboration with other HTA organisations to reduce duplication

SMC Advice

Sampling Frame

SMC Advice – method 1

Medicine Profiles ( n=74)

• Not Recommended - 20/57 (35%) • Accepted / Restricted – 54/149

(36%)

SMC Advice – method 2

• Case study – Etanercept – Medicine use in psoriatic arthritis – Implementation of SMC Etanercept

Protocol (Aug 2006)

• Budget Impact – Compare estimate and actual spend

(n=28)– Focus group to understand how NHS

boards use this information

SMC Advice – Key FindingsNot Recommended advice (n=20)

• 65% of advice issued within 6months of medicine launch date

• Use before SMC advice (n=20)– £1.4m ( context - £3.7billion)

• Use after SMC advice 2005/6 (n=10)– £1m ( 0.1% of drugs bill )

SMC Advice - Key FindingsSMC not recommended advice (n=20)

Limited use relative to alternative treatments

Variation in advice issued by national bodies to NHS boards and clinicians

Lack of engagement of relevant clinical experts in early stages of SMC

SMC Advice - Key FindingsSMC accepted/restricted advice (n=54)

• 81% of advice issued within 6 months• Use before SMC advice ( n=41)

– £1m (context £3.7billion)• Insufficient robust data for hospital medicines

updateSMC Advice - Key FindingsSMC accepted/restricted advice (n=54)

Comparison of hospital and industry data

SMC Advice – Case Study

SMC Advice - Key FindingsEtanercept

Table 1: SMC etanercept protocol – Adherence of NHS boards in Scotland at August 2006

SMC advice - Key Findings Budget Impact

• Reliability of budget impact estimates– Unable to meaningfully compare data

due to series of factors

Experience of NHS Boards’ use of information– Budget information valued by NHS Boards for

local planning– Further clarity and definition required to improve

quality

Conclusions - Successes

• ADTCs have adapted and evolved in response to SMC

• SMC has good engagement with ADTCs and Pharmaceutical Industry

• Budget impact information is valued by NHS boards

Conclusions – Challenges

• Effective engagement with public partners remains a challenge

• Monitoring use of medicines is limited by availability of robust hospital medicines data and lack of patient level data

Conclusion – Future Direction

• Actions based on the factors identified which help to explain medicine use

• Development of a more consistent approach to budget impact estimates

• Actions based on findings from public partners

• Continued development of effective methodologies to assess the contribution of HTA organisations to patient care

Acknowledgements

The project team

Marion BennieLaura McIverSharon HemsBill RamsaySamuel OduroVicky CairnsCorri BlackJoy NicholsonRupert Payne

Acknowledgements

• SMC Evaluation Reference and Management Groups

• SMC (User Group / PAPIG)• SMC (Economic / Admin / Exec Team)• ADTCs and clinical networks• ABPI• Information Services Division staff, NSS • ScotCen / Scott Hill• Sue Hewitt• NHS QIS Comms team