Technology appraisals over the past 12 months were compared between NICE and the SMC to look for evidence of discrepancies and differences in approach to technology appraisal.

Using the NICE and SMC websites, published technology appraisals were examined between June 2016 and June 2017 on the NICE website. Given that the SMC typically issues guidance sooner than NICE, the corresponding SMC verdict was then compared with the NICE verdict from this timeframe. Guidance was categorised as: terminated, rejected, restricted, recommended (with patient access scheme), or recommended. SMC appraisals could also have been superseded by subsequent NICE multiple technology appraisal recommendations.

In the 12 months prior to 13^th June 2017 NICE updated 62 technology appraisals, seven of which were terminated. In total, seventeen discrepancies between NICE and SMC appraisals were identified. Removing terminated appraisals from either body, as well as SMC guidance which was superseded, there were 15 areas of discrepancy. These included: five restrictions by NICE which were accepted by the SMC, one restriction by NICE which was rejected by the SMC, and three acceptances by NICE which were rejected or restricted by the SMC. SMC guidance typically came several months before the NICE guidance, and discrepancies were not limited to a single disease area.

NICE and the SMC generally agree on their reported recommendations for new technologies, given the costs of the drugs and the local epidemiology of disease are relatively similar between England and Scotland in most cases. However, discrepancies reflect the difference in approach taken by the SMC and NICE, and are not specific to a single disease area. This study furthers the discussion in favour of bespoke SMC submissions.