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Leela Barham is a freelance health economist and policy expert. She has published in peer-reviewed journals and presented at national and international conferences. She has provided advice to the Department of Health and Social Care on policy on pricing of branded medicines to inform the negotiation of a successor to the UK’s Pharmaceutical Price Regulation Scheme (PPRS), the Voluntary Scheme for Branded Medicines Pricing and Access (VPAS), as well as worked with patient groups, the NHS, pharmaceutical companies and many others internationally on the economics of healthcare and pharmaceuticals. Contact Leela on firstname.lastname@example.org
The Innovation Scorecard was developed to track compliance with NICE Technology Appraisals. Leela Barham reviews its latest update.
The latest iteration of the English Innovation Scorecard has been published; this time it’s been brought up to date, being hosted on a new web platform, launched on April 13, 2017.
The Innovation Scorecard concept first came about in Innovation, Health and Wealth (IHW), with the final report published late in 2011. After taking stock, IHW cumulated in a number of actions with the aim of accelerating adoption and diffusion of innovation in the NHS, one of which was to ‘develop and publish an innovation scorecard to track compliance with NICE Technology Appraisals’.
Underlying all the effort in the Innovation Scorecard is the frustration that even when the National Institute for Health and Care Excellence (NICE) says ‘yes’ to a new medicine, the wider NHS may not always use it. The reasons are probably varied; it’s possible that despite efforts to have leading clinicians engaged in the development of NICE technology appraisals that they simply don’t agree with NICE recommendations, the local NHS may be concerned about the financial consequences, some clinicians just haven’t found the time to read the guidance or perhaps that in reality that there are idiosyncratic patient reasons to depart from the guidance.
The Scorecard can’t help unpick these likely myriad and interacting factors that drive what is actually prescribed. The Scorecard can only prompt reflection, and with luck, action to try to address the root causes. This should always be driven by the acknowledgement that there is a potential missed opportunity for patients to benefit from what are, after all, considered both clinically and cost-effective medicines by NICE.
The latest iteration of the Scorecard builds on the experience since 2012, but also a push to make it more useful. The Accelerated Access Review (AAR), published in 2016 – an indicator that IHW hadn’t gotten to the bottom of the challenge of uptake of innovation – noted that the Innovation Scorecard wasn’t used all that much. (As an aside, the full Government response to the AAR is still awaited with Brexit and a new industrial strategy with a deal for the life sciences probably distracting Government from doing so... perhaps we can expect yet another look at access to innovation, say, by 2021?)
Putting the Innovation Scorecard on a web platform may help make it user-friendly, and it’s the result of consultation with users. The web platform means that anyone can look at the data with relative ease (versus the excel sheets that used to be used), be that at the national, regional or local (Clinical Commissioning Group) level.
Cynics might say that such reflection on variation in uptake isn’t going to happen within the NHS, when they have other, more pressing, issues to contend with. At the very least by improving the Innovation Scorecard, no-one can argue that they didn’t have a tool to help them. Will it be others, patients, and groups that represent them, that will use the Scorecard to hold the system to account?
Other changes to the Scorecard include the introduction of groups of medicines and how their use varies within England; the idea, according to NHS Digital, is that this is ‘more informative than only showing uptake of the individual medicines in isolation.’ The groups include medicines to treat acute coronary syndrome, diabetes, multiple sclerosis and stroke medicines (NOACS) in primary and secondary care.
Closer to the original ambition for the Scorecard is an analysis to compare uptake with expected uptake based on a NICE TA. That’s not easy to do; you need not only to get a measure of use but also an estimate of use that would be in line with the NICE TA and work out the difference. That’s not always straightforward as NICE guidance can be interpreted differently even aside from knowing just how many patients there may be, and of those, how many will be eligible according to any ‘optimization’ of use that may appear in the NICE TA. The latest analysis reveals mixed experience; 11 medicines are used less than expected and just three as expected, and one higher.
The Scorecard may yet be improved further, as everyone is invited to share their views via a survey. Why not take a look?