Did ICER think Zolgensma's price was justified?
ICER first said it needed to be under $900,000; on approval day it revised upwards to $1.2–2.1 million under generous assumptions — but critics argued Novartis's benchmark was Spinraza, itself priced at more than seven times standard cost-effectiveness thresholds.
ICER's view changed. Its final April 2019 report concluded Zolgensma would need to be priced under $900,000 to be cost-effective. On approval day, after considering new data in pre-symptomatic infants and assuming long-lasting benefit and routine newborn screening, ICER updated its range to $1.2 million to $2.1 million per life-year-gained benchmark, and said the price fell within the upper bound of that range. Critics in Health Affairs argued the price was still poorly justified, noting that Novartis's comparison with Spinraza inflated its value because Spinraza itself cost $1.1 million per quality-adjusted life year gained, more than seven times standard thresholds. If Spinraza were fairly priced, they argued, its ten-year cost would be about 30% of Zolgensma's price.