(b) Current health status (c) Clinical need Treatment history relevant to this case What treatment has Q10 the patient tried? (a) What service(s) has (b) the patient been referred to and with what effect? COHORT How many patients with this condition Q11 would you expect to see per annum in a (a) population of one million? Would this cohort of patients all benefit YES (b) from this intervention? Provide details NO How severe is your patient’s condition in (c) relation to this cohort? It is crucial that you answer this question comprehensively; EXCEPTIONALITY OF THIS otherwise the panel will be prevented from considering this PATIENT application fairly. Why should this Q12 patient’s case be treated as exceptional (a) over and above other patients with similar conditions for whom this treatment is not currently available? Is this patient likely to (b) benefit significantly more than other patients with a similar condition? OTHER INFORMATION Q13 Patient’s BMI if (a) applicable to criteria Lifestyle factors if (b) applicable to criteria EVIDENCE OF EFFICACY & COST EFFECTIVENESS
(b) Current health status (c) Clinical need Treatment history relevant to this case Q10 (a) What treatment has the patient tried? (b) What service(s) has the patient been referred to and with what effect? COHORT Q11 (a) How many patients with this condition would you expect to see per annum in a population of one million? (b) Would this cohort of patients all benefit from this intervention? Provide details YES NO (c) How severe is your patient’s condition in relation to this cohort? EXCEPTIONALITY OF THIS PATIENT It is crucial that you answer this question comprehensively; otherwise the panel will be prevented from considering this application fairly. Q12 (a) Why should this patient’s case be treated as exceptional over and above other patients with similar conditions for whom this treatment is not currently available? (b) Is this patient likely to benefit significantly more than other patients with a similar condition? OTHER INFORMATION Q13 (a) Patient’s BMI if applicable to criteria (b) Lifestyle factors if applicable to criteria EVIDENCE OF EFFICACY & COST EFFECTIVENESS
ifr_application_bnssg_-_jan_2018_v1617102_n1sejWp.docx