An investigation into the effect of advice from the Scottish Medicines Consortium on the use of medicines in Scotland's Health Service

Decisions on the clinical and cost effectiveness of new medicines are delivered by health technology assessment agencies such as SMC. The effect on medicine use of a decision from these agencies is unclear. WHAT THIS STUDY ADDS With regard to medicine use in primary care, the effect of a not recommended decision from SMC is variable. Key factors that contribute to this variability include the publication of conflicting advice by differing national bodies, failure to engage with relevant clinical experts early in the review process and a lack of alternative treatments for the indication in question. At the time of this study there were significant limitations to the data regarding medicine use within the NHS. New developments promise to improve data collection. AIMS The aims of the study were to determine the effect of advice from the Scottish Medicines Consortium (SMC) on the use of medicines within Scotland's National Health Service (NHS) and generate hypotheses that may explain differences in the impact of advice on the use of individual medicines. METHODS A retrospective analysis of medicine advice issued between January 2002 and December 2005 was performed. The inclusion criterion was medicines with a 'not recommended for use' decision (NRD) from the SMC (57 out of 207 medicines submitted). The exclusion criteria were medicines used predominately in secondary care and medicines with multiple indications. In total, 20 medicines fulfilled these criteria. The volume of prescribing was measured by each medicine's gross ingredient cost to the prescribing budget. RESULTS Before the SMC published advice there was use, though limited, of all 20 medicines. After an NRD, the pattern of use was variable, with the use of some medicines stabilizing or declining but others increasing. We identified factors to help explain unexpected use in some cases. These included delays between medicine launch and initial SMC advice, the publication of conflicting advice from different national bodies and failure to engage with relevant clinical experts early in the medicine review process. CONCLUSIONS This study demonstrates the complex relationship between advice following health technology assessment and change in clinical practice. When this study was done there were significant limitations in the collection of prescribing data within the NHS, which recent changes promise to improve.