Trends in Northern Ireland HTA Guidance Adoption: NICE Shows Dominance over SMC and AWMSG

OBJECTIVES: The Strategic Planning and Performance Group (SGGP) of the Department of Health in Northern Ireland (NI) support timely introduction of medicines, ensuring that people in NI benefit from medical advances. It has a Managed Entry process based on adoption of HTA decisions from other UK bodies. This research aimed to identify trends of adoption, analysing the speed and variation of HTA guidance uptake.

METHODS: The analysis was performed on SGGP recommendations between 21^st January 2021 and 12^th May 2023, reviewed by two independent reviewers to identify the disease area, which HTA body the guidance was adopted from, the time between adoption and original publication and whether the guidance was negative or positive. The relationship between these variables was further investigated to determine if there were patterns of adoption via a qualitative synthesis.

RESULTS: 271 appraisals were identified: 181 (67%) were adopted from NICE, in line with the SGGP board that decisions made by NICE are adopted as policy, 78 (29%) recommendations were adopted from SMC and 12 (4%) from AWMSG. Of the total appraisals, 46% were in oncology with 77% guidance adopted from NICE and 21% from SMC in this disease area. Negative recommendations were also adopted, accounting for 23% of all adopted guidance since January 2021; 56% of these negative recommendations were adopted from SMC. When comparing negative decisions, 18% of appraisals had differing guidance across the HTA bodies. The majority of guidance is adopted within 6 months of initial publication from the correlating HTA body, with only 6% of technologies not adopted within this timeframe.

CONCLUSIONS: NI adopts NICE positive guidance as policy, but defaults to SMC for negative recommendations when neither HTA body have received submissions from companies. Patient access in NI to technologies recommended by NICE, SMC and AWMSG generally occurs within 6 months of their recommendation.