OBJECTIVES: Advanced Therapy Medicinal Products (ATMPs) include innovative and regenerative therapies such as gene therapy, somatic cell therapy medicinal product, and tissue engineered product. They represent major opportunity for curing many chronic disabling diseases. About 300 clinical trials for ATMPs are ongoing. Should some of these therapies reach their goal, which is considered to be likely, the impact on already constraint public payer budget would be dramatic. The objective of this project was to assess yearly cost of ATMPs for payers assuming a pay for performance split over years as long as disease do not re-emerge. METHODS: We reviewed the economic impact of curing a range of chronic disabling conditions with ATMPs. We assumed that some ATMPs might cure a disease through one treatment cycle. We computed cost per QALY by considering the avoided cost as well as disability associated to the diseases. We assumed a cost per QALY of £30,000/QALY. We considered the payment will be based on yearly basis for each patient and not at the time of drug administration. This payment scheme was chosen as drug cost might not be affordable through a single payment. RESULTS: Results showed that payment for ATMPs would range from about £10,000 to £480,000 per year and per cured patient depending on conditions. Avoided costs represented the main driver of the yearly ATMPs price, while generated QALY was comparatively smaller. These yearly payments are among the highest for rare disease driven by orphan drug prices avoided, while they are the lowest for chronic conditions with episodic clinical manifestation such as depression (assuming a recurrence every 5 years). CONCLUSIONS: ATMPs cost might represent a source of important financial liability for public payers in a short future. This study raised awareness about need for new payment schemes for ATMPs and new sources of funding.