Date post: | 02-Jan-2016 |
Category: |
Documents |
Upload: | brendan-hopper |
View: | 37 times |
Download: | 0 times |
SMC Evaluation Programme
Overview
• Context• Evaluation Programme
– Stakeholders– SMC advice
• Conclusions
Context
• SMC established October 2001• SMC first advice April 2002
Remit To provide advice to NHS boards and their ADTCs across Scotland about the status of all newly licensed medicines, all new formulations of existing medicines and new indications for established products
Assessment process
Proforma
Pharmacy assessment Team
Health Economics group
NDC SMC
Submitted by company
Critical Appraisal of submission
ScientificAdvisory
Committee
Company response
Patient group
Advice in context of
NHS Scotland
Evaluation Programme
1. Stakeholders
2. SMC advice
Programme Delivery
• Structure– Project Team – Management Group – Reference Group – SMC Executive Team
• Timescale– 2 year programme (April 06 - March 08)
Stakeholders
Stakeholders – methods 1Impact on ADTCs role and function
• 2000• 2002• 2003/4
+ +
• 2006/7Review ofPublic
information
• Workshop June 2007 ADTCs n~ 60
Stakeholders – methods 2Engagement with stakeholders
Pharmaceutical Industry Workshop (n~100)
Public Partners*Postal questionnaires and interviews (n=154)
+ +ADTCs Workshop
(n~60)
* ScotCen – Scottish Centre for Social Research
Stakeholders - Key FindingsImpact on ADTCs’ role and function
Theme
Medicines Reviewed
Structures and processes
Implementation / Communication
Evaluation and monitoring
Evidence of consistency
2000
Variable: 3-91 per annum
Move from Trust to ADTCs Variation in discipline membership and skill set
Variable from clinician feedback to formulary inclusion
Challenging due to resources available
Variation in decisions made by NHS Boards
2006/7
All SMC advice
Continual evolving structures Variable discipline membership
Formulary management well established (move from lists to pathways) . More use of IT
Using available local and national data were possible. Little evaluation of impact of changing processes
Clarity of handling of SMC ‘not recommended’ adviceLocal decision systems for handling accepted /restricted SMC advice
Key FindingsEngagement with Stakeholders
ADTCs Public Partners Pharmaceutical Industry
Successes of engagement with SMC
Single source of timely advice
Reduction in ADTC evaluation of primary evidence
Quite successful where understood by groups
Robust, transparent processes
Industry recognised as partner
Challenges of engagement with SMC
Non submission to SMC Clarity for media and
patients of the role of local formularies
Limited awareness at time of survey of SMC (41%), its website and processes (33%)
Variation in how NHS boards implement advice
Lack of awareness of how companies contact industry reps on SMC
Improving engagement with SMC
Succession planning for SMC members
Evaluation of selected medicines licensed before SMC
E-mail to inform groups of relevant medicines
Inviting groups to attend SMC
Earlier access to economic checklist
Collaboration with other HTA organisations to reduce duplication
SMC Advice
Sampling Frame
SMC Advice – method 1
Medicine Profiles ( n=74)
• Not Recommended - 20/57 (35%) • Accepted / Restricted – 54/149
(36%)
SMC Advice – method 2
• Case study – Etanercept – Medicine use in psoriatic arthritis – Implementation of SMC Etanercept
Protocol (Aug 2006)
• Budget Impact – Compare estimate and actual spend
(n=28)– Focus group to understand how NHS
boards use this information
SMC Advice – Key FindingsNot Recommended advice (n=20)
• 65% of advice issued within 6months of medicine launch date
• Use before SMC advice (n=20)– £1.4m ( context - £3.7billion)
• Use after SMC advice 2005/6 (n=10)– £1m ( 0.1% of drugs bill )
SMC Advice - Key FindingsSMC not recommended advice (n=20)
Limited use relative to alternative treatments
Variation in advice issued by national bodies to NHS boards and clinicians
Lack of engagement of relevant clinical experts in early stages of SMC
SMC Advice - Key FindingsSMC accepted/restricted advice (n=54)
• 81% of advice issued within 6 months• Use before SMC advice ( n=41)
– £1m (context £3.7billion)• Insufficient robust data for hospital medicines
updateSMC Advice - Key FindingsSMC accepted/restricted advice (n=54)
Comparison of hospital and industry data
SMC Advice – Case Study
SMC Advice - Key FindingsEtanercept
Table 1: SMC etanercept protocol – Adherence of NHS boards in Scotland at August 2006
SMC advice - Key Findings Budget Impact
• Reliability of budget impact estimates– Unable to meaningfully compare data
due to series of factors
Experience of NHS Boards’ use of information– Budget information valued by NHS Boards for
local planning– Further clarity and definition required to improve
quality
Conclusions - Successes
• ADTCs have adapted and evolved in response to SMC
• SMC has good engagement with ADTCs and Pharmaceutical Industry
• Budget impact information is valued by NHS boards
Conclusions – Challenges
• Effective engagement with public partners remains a challenge
• Monitoring use of medicines is limited by availability of robust hospital medicines data and lack of patient level data
Conclusion – Future Direction
• Actions based on the factors identified which help to explain medicine use
• Development of a more consistent approach to budget impact estimates
• Actions based on findings from public partners
• Continued development of effective methodologies to assess the contribution of HTA organisations to patient care
Acknowledgements
The project team
Marion BennieLaura McIverSharon HemsBill RamsaySamuel OduroVicky CairnsCorri BlackJoy NicholsonRupert Payne
Acknowledgements
• SMC Evaluation Reference and Management Groups
• SMC (User Group / PAPIG)• SMC (Economic / Admin / Exec Team)• ADTCs and clinical networks• ABPI• Information Services Division staff, NSS • ScotCen / Scott Hill• Sue Hewitt• NHS QIS Comms team