OBJECTIVES:

The National Institute for Health and Care Excellence (NICE) offers a fast-track appraisal cost-comparison pathway (FTA) for health technologies that exhibit similar or greater health benefits at a similar or reduced cost to technologies already approved for the same clinical indication. The Scottish Medicines Consortium (SMC) provides two pathways, a full submission using a cost-comparison model or an abbreviated submission requiring a simpler comparison of acquisition costs for interventions and comparators within the same therapeutic class. Recent submissions to NICE and the SMC were reviewed to investigate the use of the SMC pathways and their success rates.

METHODS:

The 10 most recent NICE FTAs with published committee papers were identified (from December 2022). Details extracted included the comparative efficacy evidence provided, costs modelled and critiques by the External Assessment Group (EAG). The equivalent SMC submission was identified, and the equivalent information was extracted.

RESULTS:

10 FTAs were identified across arthritis (n=3), ophthalmology (n=4), plaque psoriasis (n=2) and multiple sclerosis (n=1). 8 of these were submitted to the SMC via different pathways, 3 via a full submission and 5 via an abbreviated submission. 2 out of the 3 full SMC submissions compared the intervention to comparators within the same therapeutic class. All submissions received positive recommendations. Cost-comparison models submitted to NICE and SMC for full submissions were broadly similar; time horizons were aligned between equivalent submissions and all models considered similar cost categories (3/3). Overall, critiques from the EAG and New Drugs Committee on the comparators and modelling approaches were comparable.

CONCLUSIONS:

The SMC abbreviated pathway was used for most submissions, suggesting there could be scope for NICE to simplify the FTA process for some indications and treatments. In addition, our research suggests cost-comparison models developed for NICE FTAs are likely to require minimal adaptations to be suitable for SMC full submissions.