OBJECTIVES: England and Scotland have separate health technology assessment (HTA) programs, usually requiring independent submissions with jurisdiction-specific cost-effectiveness estimates. The objective of this research was to compare cost-effectiveness assessments for National Institute for Health and Care Excellence (NICE) submissions with those for Scottish Medicines Consortium (SMC), and how these affected submission outcomes.

METHODS: All publicly-available technology appraisal advice was extracted from the NICE and SMC websites from January-2010 to January-2018. Superseded, suspended, terminated, and non-submissions were excluded. Both manufacturers’ base-case ICERs and agencies’ preferred ICERs were extracted for products assessed by both NICE and SMC, where available.

RESULTS: As of January-2018, 129 products had been appraised by both agencies across 174 indications. Where reported, manufacturers’ base-case ICERs for NICE were generally similar to base-case ICERs submitted to SMC (median: £24,280 versus £24,215, respectively, excluding cases of dominance), but did vary substantially in some appraisals, such as where a different patient-access scheme or subgroup was submitted. Committee-preferred decision-making ICERs were on average 29% higher than the manufacturer’s base-case ICER for NICE, but the final decision-making ICER was not generally reported for SMC. While all-but-two evaluated NICE submissions included a cost-utility analysis, 14/174 (8%) SMC submissions were primarily assessed on a cost-minimisation basis. There was evidence for differences in willingness-to-pay thresholds: positive outcomes for submissions reporting base-case ICERs <£20,000 per-QALY were 100% for NICE versus 91% for SMC; between £20,000-£30,000 were 100% versus 79%, respectively; and >£30,000, were 80% versus 73%, respectively. High ICERs were more acceptable to both agencies where decision-modifiers such as substantial survival benefit, innovation, or unmet need applied.

CONCLUSIONS: Differences in NICE and SMC processes can lead to variations in submission outcomes, due to differing assessments of cost-effectiveness and possibly, willingness-to-pay thresholds. More alignment between NICE and SMC or transparency where methods differ could help reduce discrepancies in patient access between jurisdictions.