OBJECTIVES:

This project aims to build an understanding of UK reimbursement challenges, specifically around the acceptance of endpoints in neurological conditions. The initial stage aims to identify the number and type of submissions in neurological conditions made to NICE and SMC, enabling future analysis of these submissions.

METHODS:

Past HTA and highly specialised technologies (HST) submissions to NICE and SMC were reviewed to identify submissions for neurological diseases (excluding general mental health). A search was performed up to November 2021 to identify potentially relevant submissions, followed by targeted keyword searching and manual sifting to identify relevant submissions. A characterisation and analysis of these submissions was performed.

RESULTS:

Between 2001 and 2021, there were 21 NICE appraisals (19 STA [90%], 2 MTA [10%]) and 85 SMC submissions (50 full [59%], 21 abbreviated [25%], 13 re-submissions [15%], 1 non-submission [1%]) for neurological conditions. Mean number of submissions per year across both agencies was 5 (range 2-10). Since 2018, there has been a marked increase in NICE appraisals (13/21 [62%]), unlike SMC during the same period (12/85 [14%]). The most frequently assessed conditions by both NICE and SMC were multiple sclerosis (MS) (n=13/21 [62%] and n=22/85 [28%], respectively) and migraine (n=4/21 [19%] and 8/85 [9%]). SMC also conducted multiple appraisals for schizophrenia (n=15/85 [21%]), ADHD (n=9/85 [11%]), Parkinson’s Disease (n=11/85 [12%]), Bipolar disorder (n=8/85 [28%]), epilepsy (n=7/85 [8%]) and Alzheimer’s disease (n=5/85 [6%]); NICE has otherwise only completed single assessments for some of these conditions, and none for others.

CONCLUSIONS:

The SMC has assessed far more technologies in neurological conditions than NICE, but recently NICE has conducted relatively more appraisals. MS technologies are the most frequently assessed by both agencies. Future research includes further appraisal analysis.