Patient Interest Seminar 21st May

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Patient Interest Seminar 21st May

• Dr. Andrew Power
• Vice Chair
• New Drugs Sub group

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Objectives

• SMC processes
• NDC SMC
• Health Board Formulary processes
• QALY tables

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Scottish Medicines Consortium
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Composition

• SMC multidisciplinary (30)
• Physicians, pharmacists, health economists
• NHS executives/finance managers
• Pharmaceutical industry nominees (ABPI)
• Public partners (3)
• PR, Scottish Government representatives
• NDC - clinical/scientific (15)
• Physicians, pharmacists, nurse, health
  economists, academics, industry nominees
• Including Pharmacy Assessment Team and Health
  Economics Team

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Safety, quality and efficacy
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SMC Remit

• National consortium of representatives of local
  drug and therapeutic committees
• Provide advice to NHS Boards on
• New medicines
• New formulations of older medicines
• Major new indications
• Assess the need and clinical effectiveness
  including comparative efficacy
• Assess the comparative cost-effectiveness
• DO NOT assess safety

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Assessment process
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Scottish Medicines Consortium

• Produce a Detailed Advice Document (DAD)
• SMC may
• Accept medicine for use in NHS Scotland
• Accepted for use in NHS Scotland (with
  restrictions)
• Not recommend for use in NHS Scotland
• All advice can be found on the SMC website
  www.scottishmedicines.org.uk

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Count and annual share of SMC decisions,
(excluding abbreviated and non-submissions)
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QALYs

• They are based on the number of years of life
  that would be added by the intervention. Each
  year in perfect health is assigned the value of
  1.0 down to a value of 0 for death.
• If the extra years would not be lived in full
  health, for example if the patient would lose a
  limb, or be blind or be confined to a wheelchair,
  then the extra life-years are given a value
  between 0 and 1 to account for this.

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Cost-Effectiveness vs. Effectiveness

• DRUG B
• 96 Cure Rate
• 10 / patient

• DRUG A
• 90 Cure Rate
• 1 / patient

With thanks to Dr. Andrew Walker, University of
Glasgow
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Cost-Effectiveness vs. Effectiveness

• DRUG B
• 96 Cure Rate
• 10 / patient
• 96 cures / 1000

• DRUG A
• 90 Cure Rate
• 1 / patient
• 900 cures / 1000

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Post SMC local formulary process
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What is a formulary?

• Generally, a list of medicine which the vast
  majority of prescribing should come from
• May be a simple list
• May include additional information and guidance
• Can be applicable from anything from a single
  practice, to health board to country (e.g. BNF)
• Formulary Management is the term given all
  processes linked to the Formulary including
  production, review and measurement of adherence

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Why produce a Formulary?

• Promote cost-effective drug use
• Maximise given resources
• Limited resources
• Increasing pressures
• Minimise risk
• Maximise procurement

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Fact or Fiction?

• Medicines not accepted by SMC can not be
  prescribed by GPs
• Fiction GP in general should follow SMC advice,
  but in exceptional cases may prescribe non-SMC
  medicines
• In most health boards, GPs are able to appeal to
  have a medicine reconsidered for inclusion in the
  local formulary
• Fact most health boards have an appeal process
  that GPs can access
• GPs are independent contractors and do not have
  to stick to any agreed local formulary
• Fact with some fiction GPs are independent
  contractors and can prescribe non-formulary
  medicines where they see fit, though they are
  requested to follow local formularies.
• However, it should be noted that GPs are
  contracted to an NHS health board and widespread
  prescribing of medicines not accepted by SMC or
  non-Formulary without good reason could be deemed
  as inappropriate prescribing which may be
  considered a breach of contract.

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ADTC

• ADTC consider SMC advice for local implementation
• Consider local needs of the population
• Opinions of relevant local clinicians and groups
• Consider what is on Formulary already
• Generally, approximately 85 of medicines
  accepted by SMC will be added to the Formulary

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Formulary adherence (GGC)

• The Preferred List is a subset of about 350
  medicines covering conditions managed in Primary
  Care
• Current average adherence for the year is 74
• Adherence to the full formulary is unknown, but
  estimated at gt90

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Objectives

• SMC processes
• NDC SMC
• Health Board Formulary processes
• QALY tables