How does Zolgensma compare with Spinraza?
Novartis framed Zolgensma as cheaper than ten years of Spinraza at $4.25M — but ICER put Spinraza's lifetime cost at $2.4M, not $4.25M, meaning at a fair price ten years of Spinraza would cost roughly 30% of Zolgensma: using an overpriced rival as a benchmark entrenches high prices across the disease area.
Spinraza (nusinersen), sold by Biogen, was the first SMA treatment and must be given repeatedly by injection into the spinal fluid. Novartis argued Zolgensma's one-time price was about half the cost of ten years of Spinraza, which costs about $750,000 in the first year. Critics said this comparison flattered Zolgensma. ICER calculated Spinraza's price equated to $1.1 million per quality-adjusted life year gained, more than seven times the highest accepted threshold, and put Spinraza's lifetime cost at $2.4 million rather than the $4.25 million implied by Novartis's framing. At a fair price, ICER said ten years of Spinraza would cost $648,000, about 30% of Zolgensma's price. A later commentary noted that when the comparator is set at $4 million over a decade, almost anything looks like a deal. Using an overpriced rival as a benchmark can therefore entrench high prices across a disease area.