NICE noted that the cost effectiveness of lenalidomide compared with standard care for people with low- or intermediate-1-risk MDS associated with an isolated deletion 5q cytogenetic abnormality when other therapeutic options are insufficient or inadequate, was sensitive to whether the patient access scheme would be realised in clinical practice. The Committee agreed that it would be critical to generate evidence to support the following: - The proportion of people who become eligible for the patient access scheme, that is, that they remain on treatment beyond 26 cycles. - The benefit of lenalidomide after 26 cycles, that is the associated overall survival and health related quality of life for those who remain on treatment beyond 26 cycles.