NICE's TA1121 cost-minimisation rule, not the QALY threshold alone, now sets the UK ATTR-CM price ceiling: any new stabiliser must beat whichever of tafamidis and acoramidis is cheaper.
NICE recommended tafamidis (Vyndaqel/Vyndamax, Pfizer) for ATTR-CM under TA696 in 2021, since updated by TA984 in June 2024, on a confidential Patient Access Scheme estimated at a 40 to 50 percent discount off UK WAC. That discount brings the modelled cost per QALY within NICE's standard £20,000-30,000 threshold and sets an effective NHS price near £12,000-18,000 a year, built on the ATTR-ACT trial's mortality benefit and a modelled QALY gain of 0.7 to 1.2. Acoramidis (Beyonttra, Bayer) cleared its own NICE bar under TA1121 in January 2026, but without a head-to-head trial against tafamidis. NICE's committee went a step further than a standard cost-effectiveness sign-off and directed clinicians to use whichever of the two stabilisers is less expensive, once administration costs, dose, price per dose, and each drug's commercial arrangement are accounted for.
That cost-minimisation directive changes the pricing question for any third entrant. It is no longer enough to clear £20,000-30,000/QALY against a fixed comparator; a new stabiliser has to beat whichever of tafamidis and acoramidis is cheaper at the moment of appraisal, since NICE will simply direct prescribers to the lower-cost option again. Vutrisiran (Amvuttra, Alnylam) illustrates the ceiling from the silencer side: its list price alone runs near £383,000 a year, brought down by its own confidential Patient Access Scheme under TA868 for ATTR-PN and TA1115 for ATTR-CM. NHS England projects total ATTR-CM spend at £80-120 million a year once roughly 5,000 patients are on treatment, a budget-impact ceiling that any new commercial arrangement has to sit under.
UK ATTR pricing — NICE's cost-minimisation rule already forces tafamidis and acoramidis into direct price competition
| Agent | NICE Route | List/WAC Price | Effective NHS Price |
|---|---|---|---|
| Vyndaqel/Vyndamax (tafamidis) | TA984 (updating TA696) | UK WAC (undisclosed) | ~£12,000-18,000/yr after ~40-50% PAS discount |
| Beyonttra (acoramidis) | TA1121, Jan 2026 | Similar order to tafamidis WAC | Directed to match whichever stabiliser costs less, post-PAS |
| Amvuttra (vutrisiran) | TA868 (ATTR-PN) / TA1115 (ATTR-CM) | ~£383,000/yr list | Confidential PAS discount off list |
Sources: NICE TA984 (tafamidis, updating TA696); NICE TA1121 (acoramidis, 14 January 2026); NICE TA868 and TA1115 (vutrisiran); NHS England ATTR-CM service commissioning documentation.
What this model answers
Every section answers a named commercial question your team is asking, scoped to your asset.
Delivers
- TA984 QALY modelling and PAS discount mechanics
- the £12,000-18,000/year effective-price precedent
- the corridor a new stabiliser's commercial arrangement has to land inside
Delivers
- TA1121's least-expensive-stabiliser mechanic explained
- what it means for a new entrant that cannot rely on a fixed QALY comparator
- commercial-arrangement structuring options
Delivers
- NHS England's ATTR-CM spend projection at peak patient volume
- vutrisiran's £383,000 list-to-PAS ladder as the silencer-side benchmark
- budget-impact modelling for a new commercial arrangement
Custom model delivered in 72 hours.
Commission This ModelWhat's inside
- Why TA1121's cost-minimisation rule, not the QALY threshold alone, decides a new stabiliser's UK price
- Pressure-tested against tafamidis's and acoramidis's live PAS precedent before the rest of the model is built out
- How tafamidis's 40-50% PAS discount lands its effective price at £12,000-18,000/year
- Where a new stabiliser's commercial arrangement needs to sit inside that corridor
- How NICE's least-expensive-stabiliser directive works mechanically
- What it means for pricing a third entrant with no head-to-head data
- Vutrisiran's list price and its TA868/TA1115 PAS discount as the silencer-side comparator
- What the analogue supports for a new agent's own commercial-arrangement depth
- How TA984's QALY gain of 0.7-1.2 was modelled
- Where the evidence base could support a premium over the tafamidis/acoramidis floor
- The WAC, PAS discount, and effective NHS price components decomposed line by line
- The 40-50% discount depth already observed in TA984
- Sequencing recommendation against the £80-120M peak-spend ceiling
- Conservative, base, and aggressive NHS uptake scenarios
- The open pricing questions your team must close before the UK NICE submission is locked
- Structured for an internal pricing committee session
Included with every brief
How AXLRx builds this model
Prepared by MoatRx analysts.
Every AXLRx pricing model is built from primary NICE technology appraisal documents and NHS England commissioning specifications, not secondary summaries. Findings are independently verified before inclusion.
UK ATTR pricing sources: NICE TA984 (tafamidis, updating TA696), NICE TA1121 (acoramidis, 14 January 2026), NICE TA868 and TA1115 (vutrisiran), and NHS England ATTR-CM service commissioning documentation.
- Tafamidis's PAS discount estimate and £20,000-30,000/QALY clearance verified against the NICE TA984 decision document
- TA1121's cost-minimisation directive for acoramidis verified against the NICE TA1121 final guidance, 14 January 2026
- Vutrisiran's list price and PAS structure verified against NICE TA868 and TA1115 final guidance
Frequently asked questions
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AXLRx delivers ATTR pricing strategy models built for market access and pricing teams navigating NICE's cost-minimisation rule and the NHS ATTR-CM budget ceiling. Custom model in 72 hours.
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