23 During Ipilimumab’s appraisal NICE estimated the QALY to be ∼£240,000 with an ICER of £54,000–£70,000 while within NSCLC the ICER of Nivolumab and Pembrolizumab was $1,17,000 and $98,000 in primary and recurrent disease translating into a 3.5 month PFS.13 Importantly however when analysing the cost-effectiveness of Nivolumab according to tumour PD-L1 expression levels a trend to cost-effective satisfying the USA QALY threshold was seen, $1,12,311 (≥1%), $72,897 (≥5%), $78,921(≥10%) with similar results found with Pembrolizumab monotherapy. The gene discussed is CD274; the disease is non-small cell lung carcinoma.