Table 1.
Application of ‘special circumstances’ in the appraisal of some products with incremental cost-effectiveness above £30 000 per quality adjusted life year
| Topic | ICER ('000s) | Severity | End of life* | Stakeholder persuasion | Significant innovation | Disadvantaged population | Children |
|---|---|---|---|---|---|---|---|
| Riluzole (motor neurone disease) | 38–42 | ✓ | ✓ | ✓ | |||
| Trastuzumab (advanced breast cancer) | 37.5 | ✓ | ✓ | ||||
| Imatinib (chronic myeloid leukaemia) | 36–65 | ✓ | ✓ | ||||
| Imatinib (gastrointestinal stromal tumour) | ✓ | ✓ | ✓ | ||||
| Pemetrexed (malignant mesothelioma) | 34.5 | ✓ | ✓ | ✓ | |||
| Ranizumab (age-related macular degeneration) | ≫30 | ✓ | ✓ | ||||
| Omalizumab (severe asthma) | >30 | ✓ | ✓ | ✓ | |||
| Sunitinib (advanced renal cancer) | 50 | ✓ | ✓ | ✓ | ✓ | ||
| Lenalidomide (multiple myeloma) | 43 | ✓ | ✓ | ✓ | |||
| Somatotropin (growth hormone deficiency) | n/a | ✓ | ✓ | ✓ | |||
| Chronic subcutaneous insulin infusion (childhood Type 1 diabetes) | n/a | ✓ | ✓ |
*
End-of-life considerations have only been explicitly taken into account since January 2009 on the basis of supplementary advice from the Institute to the Appraisals Committee. ICER, incremental cost-effectiveness ratio (£ per quality-adjusted life year).