A cost-based-plus pricing approach for repurposed tiratricol in the treatment of Allan-Herndon-Dudley syndrome

Tiratricol, an old thyroid drug, has been repurposed as an orphan drug for Allan-Herndon-Dudley syndrome, a rare genetic disorder affecting thyroid hormone transport. Despite public contributions to its repurposing, the current marketing authorization holder, Egetis Therapeutics, has projected a price of €63.500–€95.000 per-patient-per year, significantly exceeding historical costs and straining already limited healthcare budgets. This raises concerns regarding affordability and the justification for charging high prices for medicines repurposed with public funding. This study evaluates a cost-based-plus pricing approach for repurposed tiratricol across different scenarios with varying cost structures and different assumptions about patient numbers. By transparently outlining key cost components, including R&D costs, cost-of-failure, and cost-of-capital, it proposes socially acceptable pricing that reflects genuine investment needs and a reasonable profit margin. Under the maximum cost scenario, assuming fewer patients than projected by the company itself, a price of €27.600 per-patient-per-year is derived. Minimum cost scenarios and those projecting a higher number of patients yield prices ranging from €5.300 to €16.500. Given the substantial public role in tiratricol’s repurposing, this study argues in favour of the lower end of the price range, while acknowledging the need for sustainable access through formal registration, which justifies a price higher than that of the original product. This research highlights the broader ethical and economic implications of orphan drug pricing, advocating for evidence-based policies that promote transparency in cost structures. This can help ensure a more predictable, sustainable, and socially responsible business model for repurposed medicines.