To get this work started, our Director of Policy, Nick Meade, and I travelled north to Glasgow, to attend the August meeting of the Scottish Medicines Consortium (SMC). The SMC is the body that appraises all new medicines before they can be used in the NHS in Scotland, assessing their clinical and cost effectiveness. So far in 2015 the SMC has approved some 40 medicines for use in Scotland, including medicines for some rare conditions and rare cancers.
The SMC holds its monthly meeting entirely in public, appraising six or seven medicines each session. The committee, made up of representatives from the Area Drug and Therapeutics Committees from each of Scotland’s 14 geographical health boards and representatives of the pharmaceutical industry body ABPI, examines draft advice from the New Drugs Committee. They consider the medicine‘s efficacy and safety compared with existing treatments, along with health economic data such as the incremental cost-effectiveness ratio and likely budget impact. The committee also hears from Patient Interest Groups as well as a Patient and Clinical Engagement Group in cases of orphan or end of life medicines, who have the opportunity to explain how people are affected by the condition and the impact of the new medicine on patients and their carers.
The Consortium members have a chance to discuss the evidence presented to them, and ask clarifying questions of representatives of the company submitting the medicine, before taking a vote. The vote is typically the only part of the meeting conducted in private, unless there has been commercially confidential information submitted by the company. The vote is counted after the public part of the meeting is concluded, and made public about a month later.
Among the medicines being appraised in August was the controversial medicine for mucopolysaccaridosis, type IVA, elosulfase alfa, which provoked spirited discussion among the committee.
The SMC meeting was a fascinating insight into how Scotland decides whether to make a medicine available in the NHS, and very different from the processes followed in England.