Cost-effectiveness and value implications of veligrotug versus teprotumumab for moderate-to-severe thyroid eye disease in the United States.

Abstract

Background: Thyroid eye disease (TED) is a debilitating autoimmune condition. Teprotumumab is effective but costly, whereas veligrotug is a recently approved IGF-1R inhibitor requiring fewer infusions.

Research design and methods: A 1-year decision-analytic model compared veligrotug with teprotumumab from a US payer perspective. Clinical inputs came from pivotal phase 3 trials, and costs included drug, infusion, and monitoring. One-way (treatment cost, adherence), two-way, and probabilistic sensitivity analyses used willingness-to-pay (WTP) thresholds of USD 150,000 and 500,000 per quality-adjusted life-year (QALY).

Results: At a WAC of USD 450,000 per course, veligrotug's fully loaded cost was USD 459,850 versus USD 444,949 for teprotumumab in a 75-kg patient. Veligrotug was slightly more costly and no more effective (0.0149 vs 0.0161 QALYs), with a negative incremental net monetary benefit of USD 15,080 at USD 150,000/QALY. It was cost-effective in 19.2% of probabilistic iterations and became cost-effective only when fully loaded cost fell below approximately USD 444,800, corresponding to a WAC about 3.4% below launch price.

Conclusions: At current price and efficacy, veligrotug is not economically dominant over teprotumumab. A modest price reduction could achieve cost-effectiveness, while its shorter infusion course may add real-world value.