SURROGATE-TO-THRESHOLD PRICING: BENCHMARKING THE IGA NEPHROPATHY CASCADE AGAINST A DIALYSIS-REVEALED WILLINGNESS-TO-PAY
Author(s)
Omar Maoujoud, MD, PhD1, Amal Yassine, MD, PhD1, Intissar Haddiya, MD, PhD2.
1ISPOR Morocco, Research Team of pharmacoeconomics & pharmacoepidemiology, Faculty of Medicine Mohammed V University, Rabat, Morocco, 2Department of Nephrology, Faculty of Medicine, Mohammed I University, Oujda, Morocco, Oujda, Morocco.
1ISPOR Morocco, Research Team of pharmacoeconomics & pharmacoepidemiology, Faculty of Medicine Mohammed V University, Rabat, Morocco, 2Department of Nephrology, Faculty of Medicine, Mohammed I University, Oujda, Morocco, Oujda, Morocco.
OBJECTIVES: Emerging immunoglobulin A nephropathy therapies are licensed on a surrogate, the chronic estimated glomerular filtration rate (eGFR) slope, yet payers without a cost-effectiveness threshold cannot price them. We present a surrogate-to-threshold method: each therapy's eGFR-slope effect is propagated to lifetime cost-utility and benchmarked against a willingness-to-pay revealed by funded dialysis.
METHODS: A lifetime chronic kidney disease stage Markov (annual cycle, 3% discounting) was driven by an arm-specific eGFR slope from each therapy's published chronic slope; the finite-course agent entered as a durable level shift. States carried stage-specific utilities and Moroccan costs; kidney failure incurred an all-in dialysis cost. The revealed threshold was annual dialysis cost divided by dialysis utility (approximately 363,000 MAD per quality-adjusted life-year [QALY]); annuity cancellation makes it horizon- and discount-independent. For each Kidney Disease Improving Global Outcomes 2025 rung we computed incremental QALYs, the cost-utility ratio versus the reimbursed floor (renin-angiotensin system plus sodium-glucose cotransporter-2 inhibition (SGLT2i)), and the price reduction to threshold. Probabilistic (10,000 iterations, fixed seed) and one-way analyses were run.
RESULTS: SGLT2i was dominant versus renin-angiotensin system inhibition alone. Against SGLT2i, targeted-release budesonide, a finite-course level shift, added 0.5 QALYs at 2.5 million MAD per QALY, needing a 77% price reduction to reach the threshold; sparsentan, slowing the eGFR slope by 1.2 mL/min/1.73m2/year, added 2.3 QALYs at 4.1 million, needing 86%; iptacopan, slowing it by 1.5, added 3.0 QALYs at 36.9 million, needing 98%. Verdicts were robust except the finite-course agent, whose result depended on single-course durability. Estimates are illustrative, resting on proxy progression and derived dialysis inputs.
CONCLUSIONS: Propagating an eGFR-slope effect to a local price ceiling exposes an implementability gradient: the floor dominates, targeted agents need large managed-entry discounts. Validity rests on treating funded dialysis as a revealed allocation precedent, not a historical entitlement. It transfers to progressive nephropathies and revealed-threshold payers.
METHODS: A lifetime chronic kidney disease stage Markov (annual cycle, 3% discounting) was driven by an arm-specific eGFR slope from each therapy's published chronic slope; the finite-course agent entered as a durable level shift. States carried stage-specific utilities and Moroccan costs; kidney failure incurred an all-in dialysis cost. The revealed threshold was annual dialysis cost divided by dialysis utility (approximately 363,000 MAD per quality-adjusted life-year [QALY]); annuity cancellation makes it horizon- and discount-independent. For each Kidney Disease Improving Global Outcomes 2025 rung we computed incremental QALYs, the cost-utility ratio versus the reimbursed floor (renin-angiotensin system plus sodium-glucose cotransporter-2 inhibition (SGLT2i)), and the price reduction to threshold. Probabilistic (10,000 iterations, fixed seed) and one-way analyses were run.
RESULTS: SGLT2i was dominant versus renin-angiotensin system inhibition alone. Against SGLT2i, targeted-release budesonide, a finite-course level shift, added 0.5 QALYs at 2.5 million MAD per QALY, needing a 77% price reduction to reach the threshold; sparsentan, slowing the eGFR slope by 1.2 mL/min/1.73m2/year, added 2.3 QALYs at 4.1 million, needing 86%; iptacopan, slowing it by 1.5, added 3.0 QALYs at 36.9 million, needing 98%. Verdicts were robust except the finite-course agent, whose result depended on single-course durability. Estimates are illustrative, resting on proxy progression and derived dialysis inputs.
CONCLUSIONS: Propagating an eGFR-slope effect to a local price ceiling exposes an implementability gradient: the floor dominates, targeted agents need large managed-entry discounts. Validity rests on treating funded dialysis as a revealed allocation precedent, not a historical entitlement. It transfers to progressive nephropathies and revealed-threshold payers.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MSR99
Topic
Economic Evaluation, Epidemiology & Public Health, Methodological & Statistical Research
Disease
Rare & Orphan Diseases, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain), Urinary/Kidney Disorders