Key takeaways
- TA984 tafamidis recommended with a confidential simple-discount patient access scheme; its effective NHS price is not published
- £20K-30K NICE's standard cost-per-QALY threshold that tafamidis's PAS-discounted price clears
- 30 days NHS England must fund acoramidis within 30 days of TA1121's publication when it is the most suitable option
- TA1121 NICE's cost-minimisation recommendation directing clinicians to the least expensive of tafamidis and acoramidis
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 rejected tafamidis (Vyndaqel/Vyndamax, Pfizer) for ATTR-CM in TA696 (2021) and recommended it under TA984 in June 2024, with a confidential simple-discount patient access scheme. NICE found the most likely cost-effectiveness estimate to be within the range it considers an acceptable use of NHS resources, with longer-term extension data reducing the uncertainty left by the ATTR-ACT trial. 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.
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) | Confidential (simple discount PAS) |
| 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.
- What Patient Access Scheme discount does a new ATTR-CM stabiliser need to clear NICE's £20,000-30,000/QALY threshold, given tafamidis's precedent? • TA984's cost-effectiveness reasoning and how a confidential discount works • what TA1121's least-expensive-option rule means for price • the corridor a new stabiliser's commercial arrangement has to land inside
- How does NICE's TA1121 cost-minimisation directive change pricing strategy for a third stabiliser entering after tafamidis and acoramidis? • 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
- What budget impact should a new ATTR-CM entrant plan pricing against, once NICE directs prescribers to the least expensive stabiliser? • 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
What's inside
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1 · The Binding Constraint 2 pp
- 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
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2 · Price Ladder — PAS Discount to the £20K-30K/QALY Threshold 3 pp
- How tafamidis's confidential patient access scheme sets a price no competitor can see
- Where a new stabiliser's commercial arrangement needs to sit inside that corridor
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3 · TA1121's Cost-Minimisation Rule — Tafamidis vs Acoramidis 3 pp
- How NICE's least-expensive-stabiliser directive works mechanically
- What it means for pricing a third entrant with no head-to-head data
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4 · Analogue Benchmarks — Vutrisiran's £383K List-to-PAS Ladder 3 pp
- 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
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5 · Value-Based QALY Modelling & NICE Precedent 3 pp
- How NICE reached its TA984 cost-effectiveness conclusion
- Where the evidence base could support a premium over the tafamidis/acoramidis floor
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6 · GTN Waterfall & PAS Discount Layers 3 pp
- The WAC, PAS discount, and effective NHS price components decomposed line by line
- Why the discount depth in TA984 is confidential, and what a new entrant can and cannot infer
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7 · Launch Sequencing & NHS Spend Scenarios 4 pp
- Sequencing recommendation under NICE's least-expensive-option rule
- Conservative, base, and aggressive NHS uptake scenarios
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8 · Client Alignment Questions 2 pp
- The open pricing questions your team must close before the UK NICE submission is locked
- Structured for an internal pricing committee session
Appendix and source ledger included · 45-minute analyst readout included with delivery
Custom model delivered in 72 hours.
Assess this reportIncluded with every brief
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Commission this model
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.
- 1. Submit your requestSpecify your indication, target NICE pathway, and comparator scope.
- 2. Scoping callAXLRx analyst confirms PAS and QALY-threshold assumptions before building.
- 3. DeliveryResearch-verified pricing model in 72 hours with optional analyst readout.
How AXLRx builds this model
Prepared by MoatRx analysts on the AXLRx commercial consulting engine.
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
Deliverables What formats are included with every model?
Every commissioned Pricing Strategy Model includes an editable 12-sheet Excel model (Price Ladder, QALY Modelling, Analogue Benchmarks, Value-Based Modelling, GTN Waterfall, Launch Sequencing, Revenue Scenarios, Sensitivity, NICE Landscape, QC, Sources) and a PDF methodology brief. There is no PowerPoint deck: a pricing model is built to be worked in directly, not presented from. An optional 45-minute analyst readout call is included.
Sources How is the pricing evidence verified?
AXLRx builds from primary sources only: NICE technology appraisal documents, NHS England commissioning specifications, and MHRA approval records. No secondary market-research summaries. Every PAS estimate, QALY figure, and NHS spend projection is independently verified before inclusion.
Customisation Can I model a specific NICE pathway or comparator set?
Yes. The intake form captures your indication, target NICE pathway (STA, HST, MAA), comparator class, and QALY threshold assumption. A scoping call confirms scope before research starts. Commission through the intake form to begin.