An analysis of the top 20 most expensive drugs in the US

An analysis of the top 20 most expensive drugs in the US


Are acute therapies and curative drugs more affordable than chronic treatments in rare diseases?


Innovative drugs for rare diseases are increasingly expensive. Previous publications assess annual cost and group together gene/acute therapies and chronic treatments, which may not provide a complete picture. This study investigates costs of gene/acute therapies versus chronic treatments for rare diseases, on an annual and lifetime basis to provide an accurate comparison.


A literature review of PubMed and grey databases including terms: high cost, most expensive treatment, therapy, annual, lifetime was conducted to identify the most expensive drugs in the US on an annual and lifetime cost basis. 25 products were identified, and drug costs calculated using dosing, USD WAC prices, age of disease onset and life-expectancy to arrive at the top 20 most costly treatments from an annual and lifetime perspective.


On an annual basis, the top 3 most expensive drugs in the US are Zolgensma, Luxterna and Ravicti. However, considering the lifetime costs of these treatments, places them 14th, 17th and 5th respectively. In addition to Zolgensma and Luxterna, 4 further gene/acute therapies (Folotyn, Chenodal, Kymriah and Yescarta) all feature in the top 20 on an annual basis but fall at the bottom of the list based on lifetime cost. Furthermore, within the product basket, the top 3 most expensive drugs on a lifetime basis are Cinryze, Juxtapid and Takhzyro which place only 9th, 8th and 10th respectively from an annual treatment perspective. The average first year costs of $0.8M for the 6 gene/acute treatments is much higher versus $0.5M for the 14 chronic treatments. However, the most expensive lifetime cost for a chronic treatment exceeds $18.0M with an average of $9.3M compared to a lifetime average of only $0.9M for gene/acute treatments.


Consideration of the lifetime costs and overall budget impact of gene/acute therapies rather than focusing on annual costs will help manufacturers address potential payer affordability concerns.

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