Interventions of Interest:

  • Eculizumab (Soliris®, Alexion Pharmaceuticals, Inc.) 
  • Efgartigimod (Vyvgart™, argenx)

The independent appraisal committee found the evidence is adequate to demonstrate that eculizumab and efgartigimod both provide a net health benefit when compared to conventional therapy alone.

According to ICER’s health-benefit price benchmark, eculizumab would need to be priced between $13,200 – $19,400 to be considered cost-effective; efgartigimod’s price is not yet known.

Recommendations to support fair, evidence-based insurance coverage include guidance that payers should not establish step therapy requiring use of efgartigimod prior to coverage of eculizumab

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Foluso Agboola, MBBS, MPH, ICER’s Vice President of Research stated:

“Myasthenia gravis is a serious lifelong disease with life-threatening manifestations, and conventional therapy with high-dose corticosteroids remains inadequate for most patients. While our review of available evidence suggests that both eculizumab and efgartigimod appear to significantly improve function and quality of life for these patients, there are uncertainties about longer-term outcomes for efgartigimod and how it will be dosed in real-world settings. Efgartigimod’s price is not yet known, but our analysis suggests that the current list price for eculizumab is far higher than the usual thresholds for cost-effectiveness. Further, it’s important to monitor these treatments’ effectiveness in minority populations to develop a complete picture of their overall efficacy.”