NICE already accepted a 20 to 35 percent Patient Access Scheme discount off budesonide's £35,000 to 45,000 WAC to clear its standard £20,000 to 30,000 per QALY threshold, and the mandatory ACEi/ARB gate before eligibility is what sets the population this pricing math is built on.
NICE has never negotiated an IgA nephropathy price from a blank page. Budesonide (Tarpeyo, Calliditas/AstraZeneca) cleared its Technology Appraisal, TA937, with a Patient Access Scheme discount understood to sit between 20 and 35 percent off a WAC of £35,000 to 45,000 a year, and TA1128 expanded its eligibility criteria in February 2026 without reopening that discount band. Sparsentan (Filspari, Travere) followed in May 2025, pricing within the same cost-effectiveness envelope on the strength of superior proteinuria reduction, 49.8 percent versus budesonide's 31 percent. Neither drug qualified for NICE's ultra-rare Highly Specialised Technology track; both cleared the standard Technology Appraisal process against the harder £20,000 to 30,000 per QALY threshold, roughly a tenth of the ultra-rare bar.
The economics that cleared that threshold are an ESRD-delay calculation, not a straight cost comparison. A 5 to 8 year delay to end-stage renal disease saves the NHS an estimated £185,000 to 296,000 per patient in dialysis costs, since dialysis runs roughly £37,000 a year, against a drug cost of £175,000 to 360,000 over the same window at the £35,000 to 45,000 WAC. NICE judged that case close to breakeven, which is precisely why the PAS discount exists. But the price only applies to a pre-defined population: mandatory ACEi/ARB optimisation for three months before eligibility narrows the UK's 10,000 to 15,000 IgAN patients to 3,000 to 5,000 with persistent proteinuria above 0.5 to 1.0 g/g. At the standard WAC across that population, potential NHS annual spend reaches £140 to 180 million, the budget-impact scale that makes a PAS or Commercial Access Agreement close to unavoidable regardless of the clinical case.
UK IgA nephropathy pricing — the ESRD-delay case NICE already accepted
| Agent | NICE Status | WAC | PAS Discount | Cost-Effectiveness Basis |
|---|---|---|---|---|
| Tarpeyo (budesonide) | NICE-recommended, TA937 (updated by TA1128, Feb 2026) | £35,000–45,000/yr | Est. 20–35% off WAC | 5–8 yr ESRD delay; £185–296K savings vs £175–360K drug cost |
| Filspari (sparsentan) | NICE-recommended, May 2025 | Within budesonide's envelope | Comparable discount structure expected | Superior proteinuria reduction (−49.8% vs −31%) supports parity pricing |
Sources: NICE TA937 and TA1128 (budesonide); NICE final guidance on sparsentan, May 2025; NHS renal replacement therapy tariff 2023-24; Renal Association IgA Nephropathy guideline 2023.
What this model answers
Every section answers a named commercial question your team is asking, scoped to your asset.
Delivers
- NICE's ESRD-delay cost-effectiveness modelling framework
- the 20-35% PAS discount range that cleared budesonide
- the breakeven mechanics behind that discount depth
Delivers
- Renal Association/KDIGO standard-of-care gate mechanics
- population sizing from 10,000-15,000 total patients to 3,000-5,000 eligible
- the £140-180M annual budget-impact calculation this pool implies
Delivers
- Sparsentan's PROTECT-trial-derived pricing position within budesonide's envelope
- Scotland (SMC) and Wales (AWMSG) divergence risk against the NICE precedent
- launch-sequencing implications across England, Scotland, and Wales
Custom model delivered in 72 hours.
Commission This ModelWhat's inside
- Why the PAS discount depth, not the WAC itself, decides whether a UK IgAN pricing case clears NICE
- Pressure-tested against budesonide's TA937 precedent before the rest of the model is built out
- How the eGFR-slope-to-ESRD-delay conversion sets the breakeven price
- Where budesonide's accepted case already prices against this mechanism
- Why IgAN's prevalence disqualifies it from the ultra-rare HST track
- The ACEi/ARB gate and its 10,000-15,000 to 3,000-5,000 population narrowing
- PROTECT vs NefIgArd evidence feeding into each drug's accepted price
- What the analogue pair supports for the next entrant's defensible WAC
- The 5-8 year ESRD delay and £185-296K per-patient savings calculation
- Discount depth required to bring WAC within the breakeven band
- WAC to net price to eligible-population spend, decomposed line by line
- The £140-180M annual ceiling at full uptake
- England (NICE), Scotland (SMC), and Wales (AWMSG) sequencing recommendation
- Conservative, base, and aggressive revenue scenarios tied to PAS renegotiation timing
- The open pricing questions your team must close before the UK launch price 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 documentation, NHS tariff data, and live registration-tracking records, not secondary summaries. Findings are independently verified before inclusion.
UK IgA nephropathy pricing sources: NICE TA937 and TA1128 (budesonide), NICE final guidance on sparsentan (May 2025), NHS renal replacement therapy tariff 2023-24, the Renal Association IgA Nephropathy guideline 2023, and the UK Renal Registry 2023 annual report.
- Budesonide's PAS discount range and TA937/TA1128 status verified against NICE technology appraisal guidance
- ESRD-delay cost-offset figures verified against NHS renal replacement therapy tariff 2023-24
- Eligible-population sizing verified against UK Renal Registry data and the Renal Association IgAN guideline's ACEi/ARB optimisation criteria
Frequently asked questions
Commission this model
AXLRx delivers UK IgA nephropathy pricing strategy models built for market access and pricing teams navigating NICE's ESRD-delay cost-effectiveness case and the ACEi/ARB eligibility gate. Custom model in 72 hours.
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