Based on the number of years of life it adds, spinal muscular atrophy therapy Zolgensma onasemnogene abeparvovec (AVXS-101) would be cost effective if priced under $1.5 million per year, according to an evidence report released on February 22nd from the Institute for Clinical and Economic Review (ICER). The SMA candidate from Novartis AG is under FDA review with a decision expected this half. ICER rolled out the evLYG metric in December to address concerns that cost per QALY could undervalue treatments that extend length of life without improving quality of life. The new metric regards any gain in length of life as benefit, and measures gains exactly the same across all conditions, regardless of age, severity of illness, or level of disability. Using cost per QALY, ICER determined that Novartis would have to price Zolgensma under $900,000 to meet the cost effectiveness threshold of $150,000 per QALY, the institute’s standard threshold. In contrast to Zolgensma, ICER found Spinraza nusinersen from Biogen Inc is not cost effective at its current price, using either cost per QALY or LYG. Spinraza costs $750,000 for the first year, and $375,000 each subsequent year. To be cost effective based on QALYs, Spinraza’s annual price would need to be reduced below $65,000 per year to meet the $150,000 per QALY threshold. Using LYGs, Spinraza’s price would need to be reduced under $72,300. Even using the higher $500,000 per QALY threshold afforded to ultra-rare drugs, ICER found that Spinraza would need to be priced under $264,000 to be cost effective.
For further information, see Biocentury Website (https://www.biocentury.com/bc-extra/company-news/2019-02-22/icers-life-year-calculation-gives-novartis-wider-pricing-ballpark-)