Shionogi ERT - Request Details

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2/3 Parts Assigned

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Names and email addresses Include all team members who should receive this report

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Why is this request being made?

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This is the first version of our request form, and we'd really value your feedback to help us make the process as user-friendly and helpful as possible.

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Part 1: My Part Name 1

Assigned to: Emily Peach (w/c 14/08/2026)

Part name

Date this information is required Must be at least 14 days from today

Why is this information required by this date?

General Information

Please provide a clear definition of the disease or condition to be assessed.

Specify the geographical scope (countries, regions, populations of interest) for the assessment.

Describe the target population characteristics (age, sex, ethnicity, risk factors).

Specify any subgroups for which you would like the outputs to be stratified.

Indicate the time horizon for assessment (e.g., last 10 years, last year, future years).

Epidemiology Data

Do you require incidence rates? Incidence is the rate at which new cases of a disease appear in a population over a certain period of time e.g. 5 new cases per 1,000 people per year.

Yes

No

Do you require prevalence? Prevalence is the total number of cases of a disease (both new and existing) in a population at a specific point in time or over a period e.g. 2% of the population are living with the disease at this point in time.

Yes

No

Do you require data on the current treatment landscape?

Yes

No

Please provide as much detail as you can on what treatment information you require and the treatments of interest.

Please provide any further information on epidemiological data you require.

Please upload any files that may provide further information to support your request

Part 2: I've named part two this

Assigned to: Emily Peach (w/c 21/08/2026)

Part name

Date this information is required Must be at least 14 days from today

Why is this information required by this date?

General Information

Please provide a clear definition of the disease or condition to be assessed.

Specify the geographical scope (countries, regions, populations of interest) for the assessment.

Describe the target population characteristics (age, sex, ethnicity, risk factors).

Specify any subgroups for which you would like the outputs to be stratified.

Indicate the time horizon for assessment (e.g., last 10 years, last year, future years).

Epidemiology Data

Do you require incidence rates? Incidence is the rate at which new cases of a disease appear in a population over a certain period of time e.g. 5 new cases per 1,000 people per year.

Yes

No

Please provide further information on the incidence rates you require e.g. specific subgroups of interest.

Do you require prevalence? Prevalence is the total number of cases of a disease (both new and existing) in a population at a specific point in time or over a period e.g. 2% of the population are living with the disease at this point in time.

Yes

No

Please provide further information on the prevalence you require e.g. specific subgroups of interest and time point/period

Do you require data on the current treatment landscape?

Yes

No

Please provide any further information on epidemiological data you require.

Please upload any files that may provide further information to support your request

My file one

Part 3: The third part

Assign

Part name

Date this information is required Must be at least 14 days from today

Why is this information required by this date?

General Information

Please provide a clear definition of the disease or condition to be assessed.

Specify the geographical scope (countries, regions, populations of interest) for the assessment.

Describe the target population characteristics (age, sex, ethnicity, risk factors).

Specify any subgroups for which you would like the outputs to be stratified.

Indicate the time horizon for assessment (e.g., last 10 years, last year, future years).

Epidemiology Data

Do you require incidence rates? Incidence is the rate at which new cases of a disease appear in a population over a certain period of time e.g. 5 new cases per 1,000 people per year.

Yes

No

Do you require prevalence? Prevalence is the total number of cases of a disease (both new and existing) in a population at a specific point in time or over a period e.g. 2% of the population are living with the disease at this point in time.

Yes

No

Please provide further information on the prevalence you require e.g. specific subgroups of interest and time point/period

Do you require data on the current treatment landscape?

Yes

No

Please provide any further information on epidemiological data you require. *

Please upload any files that may provide further information to support your request

No files

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Request Details: #23456

General Information

Requestor Information

Request Type

Feedback

Part 1: My Part Name 1

General Information

Epidemiology Data

Part 2: I've named part two this

General Information

Epidemiology Data

Part 3: The third part

General Information

Epidemiology Data

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