As part of the National Institute for Health and Care Excellence's (NICE) single 
technology appraisal (STA) process, apremilast was assessed to determine the 
clinical and cost effectiveness of its use in the treatment of moderate to 
severe plaque psoriasis in two patient populations, differentiated by the 
severity of the patient's Psoriasis Area Severity Index (PASI) score. The Centre 
for Reviews and Dissemination (CRD) and the Centre for Health Economics (CHE) 
Technology Appraisal Group at the University of York was commissioned to act as 
the evidence review group (ERG). This article provides a summary of the 
company's submission, the ERG report and NICE's subsequent guidance. In the 
company's initial submission, a sequence of treatments including apremilast was 
found to be both more effective and cheaper than a comparator sequence without 
it in both populations considered. However, this result was found to be highly 
sensitive to a series of assumptions made by the company, primarily reflecting 
the costs of best supportive care once no further treatments are available, and 
the source of utility estimates. A re-estimation of the cost effectiveness of 
apremilast by the ERG suggested that the apremilast sequence in the two 
populations was more effective, but due to high additional costs was not 
indicative of a cost-effective use of NHS resources. As such, in the final 
appraisal decision NICE concluded that apremilast was not cost effective in 
either population.