In the US, the Institute for Clinical and Economic Review (ICER) occupies a special, if not a unique position in promoting economic evaluations of pharmaceutical products that are entirely imaginary. This is not an unusual event. Through ICER’s embrace of the approximate information meme that has dominated health technology assessment for the last 30 years, it is merely trying to emulate agencies in single payer health systems such as the National Institute for Health and Care Excellence (NICE) in the UK who

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