Table 2.
Item | Yes | No | Notes |
---|---|---|---|
Clinical Effectiveness | |||
Surrogate endpoint used | □ | □ | Validation given? |
Rare disease | □ | □ | Prevalence _____ |
Serious condition | □ | □ | |
Single-armed trial | □ | □ | Matched historical cohort used? |
Pediatric population | □ | □ | Age range _____ |
Reporting of adverse consequences and risks | □ | □ | |
Size of clinical trial | _____ number of patients | ||
Length of clinical trial | _____ duration in months | ||
Extrapolation to long-term outcomes | _____ duration in months | ||
Elements of Value | Quantification | ||
Severe disease | □ | □ | |
Value to caregivers | □ | □ | |
Insurance value | □ | □ | |
Scientific spillovers | □ | □ | |
Lack of alternatives | □ | □ | |
Substantial improvement in life expectancy | □ | □ | |
Other Considerations | Notes | ||
Discounting | |||
Different discount rates explored | □ | □ | |
Uncertainty | |||
Alternative payment models explored | □ | □ |
Source: Drummond et al., 20194