OBJECTIVES: Health inequity, defined as unfair, avoidable differences in people’s health between population groups, can result in higher rates of preventable diseases and lower life expectancy. Besides social determinants, health inequities can result from differences in access to medicines across geographies. This study aimed to identify disparities in new drug recommendations made by England's National Institute for Health and Care Excellence (NICE) and Scotland's Scottish Medicines Consortium (SMC).

METHODS: New drug appraisals published on the NICE and SMC websites from 01.06.2023–31.05.2024 were reviewed; drug, indication, recommendation (including decision driver) and date were recorded. For each record, the other agency website was searched with no timeframe for a matching appraisal by drug/indication. Recommendation and publication date of the resulting matched pairs were compared.

RESULTS: Of the 77 drugs appraised by both agencies, 67 were recommended in both England and Scotland and 6 were not recommended in either. However, at the end of the of the study timeframe, 13 drugs were available in England but not Scotland (9 were under SMC review; 2 were not reviewed by SMC; 2 were reviewed by SMC but not recommended), and 8 drugs were available in Scotland but not England (3 were under NICE review; 3 were not reviewed by NICE; 2 were reviewed by NICE but not recommended). Appraisals were more often completed by NICE first (52 completed by NICE first, mean difference [MD] 9.1 months vs 25 completed by SMC first, MD 16.1 months).

CONCLUSIONS: While 78% of recommendations were aligned, differences in appraisal processes, criteria, and timelines, especially NICE's cost-effectiveness threshold, caused variations between agencies. Manufacturers also influenced access inequalities through submission timings and appraisal terminations. Greater alignment in submission and evaluation criteria between the agencies is needed to reduce disparities in medicine access.