Gene therapy and cost-effectiveness analysis: Current issues and future research

Gene therapies represent a paradigm shift in healthcare, offering the potential for one-time treatment of genetic diseases that require chronic, burdensome management. However, these transformative therapies pose distinctive challenges for traditional cost-effectiveness analysis (CEA). This review examines how CEA of gene therapies is complicated by five distinguishing attributes: rarity, one-time administration, high durable efficacy, substantial upfront costs, and potential financing challenges. We analyze approved gene therapies, ranging in price from $60,000 to over $4 million per treatment, and review US CEAs that assess long-term value, which often find list prices above thresholds but are comparable to other recent therapies. Key methodological challenges include limited data on rare diseases, inappropriate health utility sources, uncertainty about treatment durability, and potential undervaluation of transformative health improvements. Emerging solutions include innovative financing mechanisms, methodological advances, and evolving value frameworks. Developing appropriate economic assessment methods for gene therapies is crucial for ensuring patient access while maintaining innovation incentives.