title: Differences in cancer drug assessment between Spain and the United Kingdom.
abstract: OBJECTIVE
  There is no Spanish Government agency resembling the National Institute for Health and Care Excellence (NICE) in the United Kingdom (UK) that carries out a centralised evaluation and makes decisions about funding. Therefore, we aim to assess the differences between NICE and the Spanish bodies in terms of their respective processes. We compare the decisions concerning cancer drugs in the assessments made by NICE/Single Technology Appraisal with assessments made by MADRE methodology.
  
  
  METHODS
  We included all cancer drugs assessed by NICE and all MADRE reports made using a shared reports process (GENESIS) and reports from Catalonia (CAMDHA) and Andalucía (GFTHA). We compared the number of drugs assessed, the decisions taken by NICE and Spanish organizations and timelines.
  
  
  RESULTS
  Between January 2011 and December 2013 NICE appraised 24 cancer drugs. In Spain, 44 reports were produced using MADRE methodology. For the 14 drugs assessed by both NICE and Spanish bodies, NICE rejected a high proportion of the drugs (50% versus 26%). GENESIS, with a median of 8 months, made decisions more quickly than NICE (13.5 months) and GFTHA (17 months). The slowest organisation was CAMDHA (24.5 months).
  
  
  CONCLUSIONS
  More drugs are assessed in Spain than by NICE because there are more organisations in Spain doing this work and their processes are simpler. NICE rejects more drugs as it uses cost-effectiveness thresholds that lead to a 'not-recommended' decision, and Spanish bodies recommend cancer drugs for subgroups of patients where better results can be obtained. Timelines are better for Spanish Committees, probably because of the greater number of steps in the appraisal process by NICE.
authors.affiliation: Pharmacy Department, Hospital de Cabueñes, Gijón, Spain. Electronic address: analozano@icloud.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Lozano-Blázquez
authors.affiliation: Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK. Electronic address: R.Dickson@liverpool.ac.uk.
authors.forename: Rumona
authors.initials: R
authors.lastname: Dickson
authors.affiliation: Pharmacy Department, Hospital General La Mancha Centro, Alcazar de San Juan, Spain. Electronic address: mdfraga@sescam.jccm.es.
authors.forename: María-Dolores
authors.initials: MD
authors.lastname: Fraga-Fuentes
authors.affiliation: Responsable del Grupo de Investigación en Atención Farmacéutica, Universidad de Granada, Granada, Spain. Electronic address: femartin@ugr.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Martínez-Martínez
authors.affiliation: Pharmacy Department, Hospital Virgen de las Nieves, Granada, Spain. Electronic address: mangel.calleja.sspa@juntadeandalucia.es.
authors.forename: Miguel-Ángel
authors.initials: MÁ
authors.lastname: Calleja-Hernández
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D020811:Biomedical Technology; D003362:Cost-Benefit Analysis; D003659:Decision Making, Organizational; D003661:Decision Support Techniques; D017277:Drug Approval / Q000191:economics; D016527:Drug Costs; D015276:Health Care Rationing; D006295:Health Resources; D006801:Humans; D007349:Insurance, Health, Reimbursement; D020380:Needs Assessment; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics; D013030:Spain; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D057188:Workflow
chemical_list: D000970:Antineoplastic Agents
keywords: Antineoplastic agents; Decision making; Drug reimbursement; Health technology assessment