Since 2012, patients in England, Northern Ireland and Wales have been offered Botox injections on the NHS following recommendations by the National Institute for Health and Clinical Services that it could be an effective treatment for sufferers of some types of migraine. However, the muscle-paralysing injections are not available by prescription to chronic migraine sufferers in Scotland.
Although the National Institute for Health and Clinical Services (NICE) is in charge of deciding which drugs and treatments are available on the NHS in England and Wales, Northern Ireland and Scotland have their own NHS decision departments. Northern Ireland has The Department of Health, Social Services and Public Safety (HPSS), which takes advice from NICE but can disagree with its decisions for Wales and England if it wishes to, while Scotland has the Scottish Medicines Consortium who vet the therapies which are offered via the NHS Scotland.
The Scottish Medicines Consortium has twice been applied to to allow Botox as a migraine therapy on the NHS in Scotland (the applications were made in 2011 and 2013), but it rejected both, citing “a number of weaknesses in the clinical and economic data” submitted by the manufacturer which showed that it “did not offer value for money”. It has however, approved Botox as a treatment for other conditions, such as in October 2013 when it recommended that Botox be funded on the NHS as a treatment for people with MS experiencing overactive bladder symptoms.
It could be a popular treatment if approved. An estimate has been made that approximately 4,700 patients in Scotland would be eligible for the treatment, but this would cost the Scottish medicines budget an extra £108,000 a year – increasing to £308,000 in year five. The SMC decided this cost would have “significant service implications” for the NHS. Although not many migraine sufferers in Scotland are altogether happy with the service they are getting as it is. Research undertaken by The Migraine Trust has found that less than 19% of chronic migraine sufferers are happy with their current treatment, and that 75% of them have already tried at least five different medications.
Elsewhere in the UK this would make them eligible for a Botox prescription, and though it is true that migraine sufferers in Scotland are free to have the procedure privately, it costs between £500-£600, while one cycle of Botox treatment on the NHS costs around £350.
Another application has been made by the drug company Allergen Ltd, to make Botox (official name botulinum toxin type A) available to Scottish NHS patients. However, the decision will not be published until February 13th 2017, and given past records, it’s not looking hopeful.