OBJECTIVES: The National Institute of Health and Care Excellence (NICE) and Scottish Medicines Consortium (SMC) make recommendations on whether health technologies should be publically-reimbursed in England/Wales and Scotland, respectively, based on their clinical- and cost-effectiveness. Recently, both SMC and NICE have implemented divergent reforms to their appraisal processes including the NICE reformation of the Cancer Drugs Fund and the SMC Patient and Clinician Engagement (PACE) process. This research compares outcomes of NICE and SMC appraisals of oncology drugs over time.

METHODS: Publically-available NICE Single Technology Appraisal (STA) and SMC guidance were screened (01/01/2006-20/03/2018) and key data extracted. Statistical tests were conducted using Poisson regression models for count data analyses and Pearson’s chi-squared tests for equality of proportions.

RESULTS: NICE have conducted 174 oncology drug STAs (51% [174/342] of all STAs), averaging 13.9/year (range: 4[2005&2006]-63[2017]) with a significant increase in annual appraisals over time (p<0.001). SMC have conducted 279 appraisal of oncology drugs (22% [279/1265] of all appraisals), averaging 22.3/year (range: 15[2014]-37[2016]) with no significant change over time (p=0.07). 63% and 50% of NICE and SMC oncology appraisals, respectively, resulted in positive outcomes (defined as NICE: ‘recommended’ or ‘optimized’ and SMC: ‘accepted’ or ‘restricted’). There were clear significant increases in the proportion of positive NICE oncology STAs since the new CDF reforms (pre-2016: 51% [45/89] vs. post-2016: 76% [65/85], p<0.001) and in the proportion of positive SMC oncology appraisals since introduction of the PACE process (pre-2014: 39% [60/153] vs. post-2014: 63% [79/126], p<0.001).

CONCLUSIONS: Recent NICE and SMC reforms have both been associated with significant increases in the proportion of oncology appraisals resulting in positive outcomes. Future research on concordance rates of NICE and SMC appraisal outcomes between the same drug-indication pairings could provide valuable insights on whether these differing reforms are driving increasingly divergent appraisal outcomes.