Cost-effectiveness and value implications of veligrotug versus teprotumumab for moderate-to-severe thyroid eye disease in the United States

Background Thyroid eye disease (TED) is a debilitating autoimmune condition. Teprotumumab, the first approved biologic for TED, is effective but costly. Veligrotug, an insulin-like growth factor-1 receptor (IGF-1 R) inhibitor requiring fewer infusions, is a recently approved alternative with a confirmed wholesale acquisition cost and confirmed pivotal-trial efficacy.Research design and methods A decision-analytic model compared veligrotug with teprotumumab over 1 year from a US payer perspective. Clinical inputs came from pivotal phase 3 trials (response defined as ≥2-mm proptosis reduction); costs included drug, infusion, and monitoring components. One-way (treatment cost, adherence), two-way, and probabilistic sensitivity analyses used willingness-to-pay (WTP) thresholds of USD 150,000 and 500,000 per quality-adjusted life-year (QALY).Results At veligrotug’s confirmed WAC (USD 450,000 per course, positioned by the manufacturer at parity with teprotumumab), a like-for-like WAC-based comparison for a 75-kg patient placed veligrotug’s fully loaded cost (USD 459,850) modestly above teprotumumab’s (USD 444,949). Using veligrotug’s confirmed responder rates, it was slightly more costly and no more effective than teprotumumab (0.0149 vs. 0.0161 QALYs), yielding a negative incremental net monetary benefit (−USD 15,080 at WTP 150,000/QALY). In probabilistic analysis, veligrotug was cost-effective in 19.2% of iterations. Sensitivity analysis showed that veligrotug would become cost-effective only if its fully loaded cost fell below approximately USD 444,800 (a WAC of ≈USD 434,920, roughly 3.4% below its confirmed launch price); this threshold was essentially insensitive to adherence.Conclusions At its current WAC and efficacy, veligrotug is not a cost-saving or economically dominant alternative to teprotumumab for moderate-to-severe TED: although the manufacturer positions it at parity, a like-for-like WAC-based comparison places it modestly higher in cost without an offsetting efficacy advantage. It would become cost-effective only at a course price roughly 3.4% below its current WAC, identifying a concrete price target for value-aligned coverage. Non-price advantages, notably its shorter infusion course, may nonetheless influence real-world value.