In the UK, National Institute for Health and Clinical Evidence is involved in the health technology assessment in England, Scottish Medicines Consortium is engaged in the health technology assessment in Scotland, All Wales Medicines Strategy Group (AWMSG) perform the health technology assessment in All Wales.
Taxes are the source of financing in the UK. Department of Health provides the funds to National Health Services (NHS), England. NHS provides funds to:
Primary care services
Clinical Commissioning Groups
Department of Health: Body responsible for the policy-making and ensuring that the policies are correctly implemented.
European Medicines Agency/Medicines and Healthcare products Regulatory Agency: Bodies which are involved in the market authorization.
Once the regulatory bodies approve the drugs, the manufacturer submits evidence to NICE/AWMSG/SMC.
NICE/SMC/AWMSG: Involved in the health technology assessment.
The appraisal will be forwarded to NHS. CCGs are involved in providing the services.
National Health Services (NHS): Provides funding to healthcare providers
The UK has a free pricing system. However, not all the products are reimbursed. NICE will do a systemic assessment in England. Based on the recommendations, NHS does the price negotiation.
FACTORS CONSIDERED BY NICE TO MAKE THE ASSESSMENT:
Efficacy: Quality-adjusted life year (QALY) is used to measure efficacy. Efficacy compared with the standard of care; however, indirect methods used if trials do not include the standard of care.
Cost-effectiveness: Incremental cost-effectiveness ration (ICER) is used to assess cost-effectiveness.
ICER = Total cost (new technology) – Total cost (SoC)/QALY (new technology) – QALY (SoC)
<£20,000 – There are high chances of funding
>£30,000 – Fewer chances of funding
Once the product undergoes the NICE assessment, specialist pharmacist and clinical discusses, fill the form and send it to the DTC/medicines group. Medicines group will include the drug in the formulary.
If NICE has not conducted the assessment
If NICE has not performed the assessment, clinicians in the hospital discuss with the medicines information unit. Once the request is raised, DTC will review and either approve or disapprove the request. If the product is reviewed positively by DTC, the working group will ensure that it is included in the formulary.