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Minutes of SMC meeting - Tuesday 6 May 2008

Minutes of the SMC Meeting held on Tuesday 06 May 2008
NHS Quality Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP

Present: Dr Ken Paterson (Chairman),Mrs Laura Ace, Mrs Margo Biggs, Dr Keith Brown, Professor John Cairns, Mr David Carson,Dr David Crookes, Mr Tom Divers,Dr Jonathan Fox, Dr John Gemmill,Ms Susan Goldsmith,Dr Barclay Goudie, Dr Jan Jones,Dr Harpreet Kohli, Dr Chris Lush, Dr Alan MacDonald,Dr Frances MacDonald,Dr John McElhinney,Mr Billy Malcolm,Ms Aileen Muir, Dr Anthony Ormerod,Dr Andrew Power, Dr Nick Reed, Dr Andrew Riley, Dr Sandy Simpson,Mr Keith Thompson, Mr Alistair Thorburn, Ms Angela Timoney, Mrs Sheila Tunstall-James

In Attendance: Mrs Alison Campbell,Ms Evelyn Cromarty,Dr Sara Davies,Ms Susan Downie,Mr Stephen Ferguson, Ms Veronica Moffat,Mrs Laura McIver,Ms Rosie Murray,Mr Ryan Norton, Mrs Maureen Stark,Dr Andrew Walker

Apologies: Professor James Barbour,Dr Keith Beard, Ms Ailsa Brown,Mr Colin Brown, Mrs Hazel Illingworth,Mrs Anne Lee, Dr Grace Lindsay,Mr Colin McAllister,Mrs Pat Murray, Professor Dilip Nathwani,  Ms Alex Robertson,Dr Sarah Taylor, Professor Tony Wells

 1. Welcome and Apologies for Absence

1.1 The Chairman welcomed members to the meeting and apologies for absence were noted. 

The Chairman welcomed the following who were observing the meeting:

  • Mr Ryan Norton, Communications Manager, Multiple Sclerosis Society Scotland.
  • Ms Evelyn Cromarty, Formulary Pharmacist, NHS Highland Formulary Sub Group.

The Chairman also welcomed:

  • Dr Frances Macdonald, APBI representative, who was attending her first meeting as a member of SMC. 
  • Dr John Gemmill, Chairman, Ayrshire & Arran ADTC, who was attending his first meeting as a member of SMC.
  • Dr Anthony Ormerod, Reader in Dermatology, Aberdeen Royal Infirmary who was attending his first meeting as a member of SMC.
  • Ms Veronica Moffat, Scottish Government Health Department who replaces Steven Fenocchi as SGHD observer representative on SMC.
  • Mrs Alison Campbell, NDC member, who presented a submission to SMC.

2. Declarations of Interest

2.1 The Chairman reminded members to declare interests in the products to be discussed and the comparator drugs as noted on the assessment reports.

3. Minutes of the Previous Meeting

3.1 The minutes of the SMC meeting held on 01 April 2008 were agreed as an accurate record.

4. Matters Arising From the Previous Minutes

There were no matters arising from the previous minutes.

Full Submissions

4.1 lenalidomide, 5mg,10mg,15mg and 25mg capsules (Revlimid) Celgene Europe Limited No. (441/08)

4.1.1 The SMC advice for lenalidomide (Revlimid), in combination with dexamethasone for the treatment of multiple myeloma in patients who have received at least one prior therapy, will be posted on the SMC website on Monday, 12 May 2008.

4.2 raltegravir, 400mg film-coated tablet (Isentress) Merck, Sharp and Dohme Limited No. (461/08)

4.2.1 The SMC advice for raltegravir (Isentress), in combination with other antiretroviral medicinal products for the treatment of Human Immunodeficiency Virus (HIV-1) infection in treatment experienced adult patients with evidence of HIV-1 replication despite ongoing antiretroviral therapy, will be posted on the SMC website on Monday, 12 May 2008.

4.3 ferric carboxymaltose, 100mg/2ml and 500mg/10ml solution for Injection / infusion (Ferinject)   Syner-Med (PP) Ltd No. (463/08)

4.3.1 The SMC advice for ferric carboxymaltose, (Ferinject), for the treatment of iron deficiency when oral preparations are ineffective or cannot be used, will be withheld pending confirmation of licence and availability.

Resubmission

4.4 imiquimod 5% cream (Aldara)   Meda Pharmaceuticals Ltd No. (385/07)

4.4.1 The SMC advice for imiquimod cream (Aldara), for the topical treatment of clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratoses on the face or scalp in immunocompetent adult patients when size or number of lesions limit the efficacy and/or acceptability of cryotherapy and other topical treatment options are contraindicated or less appropriate, will be posted on the SMC website on Monday, 12 May 2008.

Abbreviated Submission

4.5 buserelin 9.45mg implant for subcutaneous use (Suprefact Depot) sanofi aventis  (No. 460/08)

4.5.1 The SMC advice for buserelin, implant for subcutaneous use (Suprefact Depot), for the treatment of advanced hormone-dependent prostatic carcinoma, will be withheld pending confirmation of licence and availability.

Non Submissions

4.6 escitalopram 5, 10 and 20 mg film-coated tablets and 10 mg/ml oral drops,, (Cipralex)    Lundbeck Limited (No. 475/08)

4.6.1 The SMC advice for escitalopram film-coated tablets and oral drops, (Cipralex) for the treatment of social anxiety disorder, will be posted on the SMC website on Monday, 12 May 2008.

4.7 aliskiren (Rasilez)  Novartis Pharmaceuticals UK Ltd (No. 462/08)

4.7.1 The SMC advice for aliskiren (Rasilez) for the treatment of essential hypertension will be posted on the SMC website on Monday, 12 May 2008.

Deferred Advice

4.8 nilotinib, 200mg capsules (Tasigna)  Novartis Pharmaceuticals UK Ltd (440/08)                     

4.8.1 nilotinib (Tasigna), for the treatment of chronic phase Philadelphia chromosome positive chronic myelogenous leukaemia (CML) in adult patients resistant to or intolerant of at least one prior therapy including imatinib,  was reviewed by SMC in February 2008, but was withheld pending confirmation of the product availability. The product is now available. 

4.8.2 Advice will be sent to NHS Boards on Friday, 09 May and published on the SMC website on Monday, 09 June 2008.

5. Appeals Update

5.1 Nothing to report.


6. Patient and Public Involvement Group (PAPIG)

6.1 PAPIG Meeting 01 April 2008

The minutes of the PAPIG meeting held on 01 April 2008, were noted.

6.2 PAPIG Membership

Dr Andrew Power, NDC Co-Vice Chairman, will join PAPIG, representing the SMC Executive.  Mrs Tunstall-James welcomed Dr Power to the Group.

Mrs P Murray’s term of appointment with SMC will end in August 2008 therefore PAPIG is seeking a further replacement.  Any interested members of SMC should contact Ms Rosie Murray.  

7. New Drugs Committee: Chairman’s Report

7.1 Nothing to report.

8. Chairman’s Business

8.1 Publication and Editorial in The Glasgow Herald on Tuesday 08 April 2008

In his first interview since taking up post as Chair of SMC, Dr Ken Paterson was interviewed by Helen Puttick, Health Correspondent for the Glasgow Herald. An article was published on Tuesday 08 April and a reference to Dr Paterson’s comments also featured in the Editorial Column.  

8.2 Public Petitions Committee: Inquiry into Availability of Cancer Treatment Drugs in the NHS Scotland

A petition was recently made to the Scottish Government, by the widow of Mike Gray, a patient who successfully appealed against Grampian Health Board’s ‘exceptional circumstances’ process,  to receive treatment with cetuximab.  The Public Petitions Committee subsequently invited SMC to provide written and oral evidence to an enquiry into the issues raised in the petition on the availability of medicines for the treatment of cancer.

Dr Ken Paterson and Dr Andrew Walker represented SMC at the enquiry on 29 April 2008.

8.3 Invitation to Speak to the Verband Forschender Arzneimittelhersteller (VғA)

SMC has been invited to talk to the Verband Forschender Arzneimittelhersteller (VғA) on Thursday 19 June, 2008, in Berlin about the work of the SMC and its assessment processes.  Dr Ken Paterson, Mrs Laura McIver, Ms Ailsa Brown and Mrs Wendy Nganasurian will represent SMC.

8.4 Analysis of SMC Guidance  for  2007

Dr Andrew Walker presented a tabled paper providing an analysis of NDC and SMC’s decisions during 2007.  SMC considered the analysis, and thanked Dr Walker for providing an opportunity to review and reflect on the information. 

8.5 NICE Single Technology Appraisal (STA) Guidance

8.5.1 NICE has issued STA guidance with for the following products:

STA for  infliximab (Remicade): is not recommended for people with subacute, moderately to severely active ulcerative colitis. Subacute ulcerative colitis is defined as ulcerative colitis that would normally be managed without needing to stay in hospital overnight or having urgent surgery.

For information, in March 2007, based on a non-submission, SMC did not recommend infliximab for the treatment of moderately to severely active ulcerative colitis in patients who have had an inadequate response to conventional therapy including corticosteroids and 6-mercaptopurine or azathioprine, or who are intolerant to or have medical contraindications for such therapies. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this indication. As a result we cannot recommend its use within NHSScotland.

8.5.2 STA for abatacept (Orencia®): is not recommended for people with moderate to severe active rheumatoid arthritis who have already tried drugs known as disease-modifying anti-rheumatic drugs (including a 'TNF inhibitor'drug), which didn't work or weren't suitable.

Healthcare professionals should not stop prescribing abatacept for people who were already taking it when the guidance was issued. These patients should be able to carry on taking abatacept until they and their specialist decide that it is the right time to stop treatment.

For information, in August 2007, SMC did not recommended abatacept for use, in combination with methotrexate, for the treatment of moderate to severe active rheumatoid arthritis in adult patients who have had an insufficient response or intolerance to other disease-modifying anti-rheumatic drugs (DMARDs) including at least one tumour necrosis factor (TNF) inhibitor.  Abatacept (in combination with DMARDs) is significantly more efficacious than placebo (plus DMARDs) in rheumatoid arthritis patients who have previously failed anti-TNF therapy due to lack of efficacy. There are no data directly comparing abatacept with comparator products used in clinical practice. The manufacturer did not present a sufficiently robust economic analysis to gain acceptance by SMC.

8.5.3 Please note that NICE STAs have no status in Scotland.

8.6 Discontinued Preparations

8.6.1 lumiracoxib (Prexige), Novartis Pharmaceuticals (No. 245/06)

Following a review by The European Medicines Agency (EMEA) regarding the safety of medicines containing lumiracoxib, the Agency’s Committee for Medicinal Products for Human Use (CHMP) has concluded that the benefits of these medicines no longer outweigh their risks, and that all marketing authorisations should be withdrawn (revoked) throughout Europe.

SMC issued advice for lumiracoxib (Prexige) in March 2006 accepting for use for the symptomatic relief in the treatment of osteoarthritis only for patients in whom a COX-2 inhibitor is deemed appropriate. It appears similar in efficacy to other COX-2 inhibitors and costs slightly less. As with other COX-2 inhibitors, lumiracoxib is contra-indicated in patients with established ischaemic heart disease, cerebrovascular disease, peripheral arterial disease and moderate or severe congestive heart failure. It should be used with caution in patients who have significant risk factors for cardiovascular events. 

The SMC website has been amended to reflect that the product has been withdrawn for safety reasons.

8.6.2 valdecoxib (Bextra) Pfizer (No. 55/03)

In October 2006 in the context of a review of COX-2 inhibitors, the European Commission issued a decision for suspension of the marketing authroisation of Bextra.  The MA holder did not apply to renew the marketing authorization and the five-year marketing authorization for Bextra expired on 27 March 2008.

SMC issued advice for valdecoxib (Bextra) in September 2003, recommending for use within NHSScotland.  Valdecoxib is an additional COX-2 selective non-steroidal anti-inflammatory drug (NSAID), which is effective in the symptomatic treatment of osteoarthritis and rheumatoid arthritis. It should be considered for patients at high risk of gastro-intestinal adverse effects to nonselective NSAIDs. There is no evidence that valdecoxib has advantages or disadvantages compared with other COX-2 selective NSAIDs.

SMC issued advice for valdecoxib (Bextra) in August 2004 and did not recommend for use within NHS Scotland for the treatment of primary dysmenorrhoea. In this indication, it has shown similar efficacy and tolerability to naproxen at a higher daily cost. In general, selectivity for cyclo-oxygenase 2 may confer advantages in the treatment of patients at high risk from the gastro-intestinal adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs). However the absolute risk is likely to be very small in this target population given their age and the intermittent nature of the treatment. In addition, trials for this indication showed no apparent difference in gastro-intestinal events between valdecoxib and naproxen.

The SMC website has been amended to reflect that the marketing authorization for valdecoxib in both indications has been withdrawn.

8.6.3 inhaled insulin (Exubera)  Pfizer Ltd  (No. 254/06)

In January 2008, Pfizer ceased production of inhaled insulin (Exubera). 
                      
SMC issued advice for inhaled insulin (Exubera) in September 2006 and did not recommend for use within NHS Scotland for the treatment of adult patients with type 2 diabetes mellitus not adequately controlled with oral antidiabetic agents and requiring insulin therapy or for the treatment of adult patients with type 1 diabetes mellitus, in addition to long or intermediate acting subcutaneous insulin, for whom the potential benefits of adding inhaled insulin outweigh the potential safety concerns.  The economic case has not been demonstrated.

The SMC website has been updated to reflect that the product has been withdrawn for commercial reasons.

9. NDC Assessment Reports

Full Submissions

9.1 anidulafungin (Ecalta)  Pfizer Ltd (No. 465/08)

9.1.1 Declarations of interest were recorded in relation to this product/comparator drugs.

9.1.2 The NDC Vice Chair provided an overview of the assessment, draft advice, expert comments, and comments received from the company.  Detailed discussion followed and SMC agreed that anidulafungin (Ecalta), for the treatment of invasive candidiasis in adult non-neutropaenic patients, should not be recommended for use in NHS Scotland.  Assessors in liaison with the Secretariat, to make appropriate amendments for review by the Chairman prior to distribution of the advice.

9.1.3 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

9.2 dabigatran etexilate (Pradaxa)  Boehringer Ingelheim  (No. 466/08)

9.2.1 A declaration of interest was recorded in relation to this product/comparator drugs.

9.2.2 The NDC Vice Chair provided an overview of the assessment, draft advice, expert comments, and revised data.  A member of PAPIG presented a patient interest group submission from Anticoagulation Europe.  Detailed discussion followed and SMC agreed that dabigatran etexilate (Pradaxa) for the primary prevention of venous thromboembolic events (VTE) in adult patients who have undergone elective total hip replacement surgery or total knee replacement surgery, should be accepted for  use in NHS Scotland.  Assessors in liaison with the Secretariat, to make appropriate amendments for review by the Chairman prior to distribution of the advice.

9.2.3 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

9.3 epoetin zeta (Retacrit)  Hospira UK Ltd  (No. 46708)

There were no declarations of interest recorded in relation to this product/comparator drugs.

The NDC Vice Chair provided an overview of the assessment, draft advice, and expert comments. Detailed discussion followed and SMC agreed that epoetin zeta (Retacrit) for the treatment of anaemia associated with chronic renal failure in adult and paediatric patients on haemodialysis and adult patients on peritoneal dialysis and for treatment of severe anaemia of renal origin accompanied by clinical symptoms in adult patients with renal insufficiency not yet undergoing dialysis, should be accepted for use in NHS Scotland.  Assessors in liaison with the Secretariat, to make appropriate amendments for review by the Chairman prior to distribution of the advice.

The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

9.4 adalimumab (Humira)  Abbott Laboratories  (No. 468/08)

9.4.1 Declarations of interest were recorded in relation to this product/comparator drugs. Members with personal specific interests left the meeting for this part of the agenda.

9.4.2 The NDC Vice Chair provided an overview of the assessment, draft advice, expert comments, and comments received from the company.  Detailed discussion followed and SMC agreed that adalimumab (Humira) for the treatment of moderate to severe chronic plaque psoriasis in adult patients who failed to respond to or have a contraindication to, or are intolerant to other systemic therapy including cyclosporine, methotrexate or PUVA, should be accepted for restricted use in NHS Scotland.  Assessors in liaison with the Secretariat, to make appropriate amendments for review by the Chairman prior to distribution of the advice.

9.4.3 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

9.5 bevacizumab (Avastin)  Roche  (No. 469/08)

9.5.1 A declaration of interest was recorded in relation to this product/comparator drugs.

9.5.2 The NDC Chair provided an overview of the assessment, draft advice, expert comments and tabled expert comments, revised data/analyses and comments received from the company.  A member of PAPIG presented patient interest group submissions from Beating Bowel Cancer and Bowel Cancer UK.  Detailed discussion followed and SMC agreed that bevacizumab (Avastin) for the treatment of patients with metastatic carcinoma of the colon or rectum, in combination with fluoropyrimidine-based chemotherapy, should not be recommended for use in NHS Scotland.  Assessors in liaison with the Secretariat, to make appropriate amendments for review by the Chairman prior to distribution of the advice.

9.5.3 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

9.6 glucosamine (Alateris)  William Ransom & Son plc  (No. 471/08)

9.6.1 There were no declarations of interest recorded in relation to this product/comparator drugs.

9.6.2 The NDC Chair provided an overview of the assessment, draft advice, expert comments, and comments received from the company.  Detailed discussion followed and SMC agreed that glucosamine (Alateris) for the treatment of symptoms in mild to moderate osteoarthritis of the knee, should not be recommended for use in NHS Scotland.  Assessors in liaison with the Secretariat, to make appropriate amendments for review by the Chairman prior to distribution of the advice.

9.6.3 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

9.7 botulinum neurotoxin Type A (Xeomin)  Merz Pharma UK Ltd  (No. 464/08)

9.7.1 There were no declarations of interest recorded in relation to this product/comparator drugs.

9.7.2 The NDC Lead Assessor provided an overview of the assessment, draft advice, expert comments, revised data/analyses and comments received from the company.  A member of PAPIG presented patient interest group submissions from The Dystonia Society and Action for Dystonia, Diagnosis, Education and Research (ADDER).  Detailed discussion followed and SMC agreed that botulinum neurotoxin Type A (Xeomin) for the symptomatic management of blepharospasm and cervical dystonia of a predominantly rotational form (spasmodic torticollis), in adults, should be accepted for use in NHS Scotland.  Assessors in liaison with the Secretariat, to make appropriate amendments for review by the Chairman prior to distribution of the advice.

9.7.3 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

Abbreviated Submissions

9.8 perindopril arginine (Coversyl Arginine) Servier Laboratories Ltd  (No. 473/08)

9.8.1 A declaration of interest was recorded in relation to this product/comparator drugs.

9.8.2 The NDC Chair provided an overview of the assessment and a draft summary of advice.  Discussion followed and SMC agreed that perindopril arginine (Coversyl Arginine) for the treatment of essential hypertension, should be accepted for use in NHS Scotland.  Assessors in liaison with the Secretariat, to make appropriate amendments for review by the Chairman prior to distribution of the advice.

9.8.3 The 2.5mg and 5mg tablets are also accepted for treatment of symptomatic heart failure. 

9.8.4 Perindopril arginine preparations are also licensed for the reduction of risk of cardiac events in patients with a history of myocardial infarction and/or revascularisation, however this indication has not been reviewed by SMC.

9.8.5 The arginine salt replaces a tert-butylamine salt previously available and the 2.5mg, 5mg and 10mg arginine tablets are equivalent to the 2mg, 4mg and 8mg tert-butylamine tablets in terms of the content of perindopril base.  Generic preparations of the tert-butylamine salt are available at a lower cost than the proprietary preparations of perindopril.

9.8.6 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

9.9 perindopril arginine/ indapamine (Coversyl Arginine Plus)  Servier Laboratories Ltd (No. 474/08)

9.9.1 A declaration of interest was recorded in relation to this product/comparator drugs.

9.9.2 The NDC Chair provided an overview of the assessment and draft summary of advice.  Discussion followed and SMC agreed that perindopril arginine/ indapamine (Coversyl Arginine Plus), for the treatment of essential hypertension in patients whose blood pressure is not adequately controlled on perindopril alone and for whom this combination is an appropriate choice of therapy, should be accepted for  use in NHS Scotland.  Assessors in liaison with the Secretariat, to make appropriate amendments for review by the Chairman prior to distribution of the advice.

9.9.3 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

10. Non Submissions

10.1 lidocaine 70mg / tetracaine 70mg (Rapydan 70mg/70mg medicated plaster) EUSA Pharma Europe Limited (No: 483/08)

10.1.1 In the absence of a submission from the holder of the marketing authorisation, lidocaine 70mg / tetracaine 70mg (Rapydan 70mg/70mg medicated plaster),  for surface anaesthesia of the skin in connection with needle puncture and in cases of superficial surgical procedures, (such as excision of various skin lesions and punch biopsies) on normal skin in adults; Surface anaesthesia of the skin in connection with needle puncture on normal intact skin in children from 3 years of age, should not be recommended for use within NHS Scotland.

10.1.2 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

10.2 loteprednol etabonate 0.5% 5mg/ml (Lotemax 0.5% Eye Drops), Suspension Bausch & Lomb GmbH (No: 484/08)

10.2.1 In the absence of a submission from the holder of the marketing authorisation, loteprednol etabonate 0.5% 5mg/ml (Lotemax 0.5% Eye Drops), for the treatment of post-operative inflammation following ocular surgery, should not be recommended for use within NHS Scotland.

10.2.2 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

10.3 bosentan 62.5mg, 125mg film coated tablets (Tracleer) Actelion Pharmaceuticals UK (No: 485/08)

10.3.1 In the absence of a submission from the holder of the marketing authorisation, bosentan 62.5mg, 125mg film coated tablets (Tracleer), to reduce the number of new digital ulcers in patients with systemic sclerosis and ongoing digital ulcer disease, should not be recommended for use within NHS Scotland.

10.3.2 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

10.4 panitumumab 20mg/ml concentrate  for solution for infusion (Vectibix) Amgen Ltd (No: 486/08)

10.4.1 In the absence of a submission from the holder of the marketing authorisation, panitumumab 20mg/ml concentrate  for solution for infusion (Vectibix), as monotherapy for the treatment of patients with EGFR expressing metastatic colorectal carcinoma with non-mutated (wild-type) KRAS after failure of fluoropyrimidine -, oxaliplatin -, and irinotecan - containing chemotherapy regimens, should not be recommended for use within NHS Scotland.

10.4.2 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

10.5 teriparatide (Forsteo) 20mcg/80mcl solution for injection, in pre-filled pen  Eli Lilly & Company Ltd (No. 487/08)

10.5.1 In the absence of a submission from the holder of the marketing authorisation, teriparatide (Forsteo) 20mcg/80mcl solution for injection, for the treatment of osteoporosis associated with sustained systemic glucocorticoid therapy in women and men at increased risk for fracture, should not be recommended for use within NHS Scotland.

10.5.2 The SMC advice will be issued to NHS Boards and ADTCs on Friday, 09 May 2008.

11. Forthcoming Submissions

11.1 A list of forthcoming submissions was tabled and noted.

12. SMC User Group Forum

12.1 Market Access Schemes

Dr Frances MacDonald reported that following a request from the Scottish Government Health Department for proposals from ABPI on potential market access schemes, a draft report has now been prepared.  ABPI will review and forward a final report to SHGD for consideration in due course.

13. ADTC Feedback

13.1 Engagement between SMC and ADTCs

Dr K Paterson and Professor Dilip Nathwani are arranging to meet with individual ADTCs across Scotland in the Autumn. It will be an opportunity to share feedback with Dr Paterson. Professor Nathwani will introduce the antimicrobial prescribing initiative to ADTCs.

14. Any Other Business

14.1 NICE Judicial Review

The Court of Appeal has ruled that the National Institute for Health and Clinical Excellence (NICE) should have been more transparent in the way it made decisions over Alzheimer's drugs, specifically in relation to the economic case for these medicines.  SMC considered whether there was a need to review SMC’s processes in the light of the Court of Appeal’s decision however it was agreed that as SMC requires the manufacturer to provide an economic model  for review and NICE undertakes it’s own modelling then the two processes are not comparable and therefore a review of process was not necessary.

15. Date of the Next Meeting

15.1 The date of the next meeting was confirmed as Tuesday, 03 June 2008 at 12.30 pm (lunch from 12 noon), in NHS Quality Improvement Scotland (Glasgow Office), Delta House, 50 West Nile Street, Glasgow G1 2NP.