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Table 2 Parameters used in NPV and cost to approval calculations.

From: The potential investment impact of improved access to accelerated approval on the development of treatments for low prevalence rare diseases

  

Clinical

Surrogate

Disease

Estimated cost of treatment

Endpoint

Sample size

Time to see effect

Endpoint

Sample size

Time to see effect

   

I/II

III, IV

I/II

  

I/II

III

I/II

III

α-Mannosidosis

$300,000

6 Minute Walk Test (6MWT) (meters)

12

52

6 mos

6 mos

Urinary Man2GlcNAc (mmol/mol creatinine) measured by HPLC

10

20

3 mos

6 mos

Aspartyl- glycosaminuria

$300,000

6MWT (meters)

12

45

6 mos

6 mos

Urinary aspartylglucosamine (μmol/mmol creatinine)

6

12

3 mos

6 mos

Galactosialidosis

$300,000

6MWT (meters)

12

52

6 mos

6 mos

Urinary oligosaccharides (nmol/mg creatinine)

10

20

3 mos

6 mos

MPS IVA

$300,000

6MWT (meters)

20

52

6 mos

6 mos

Urinary keratan sulfate (ng/g creatinine)

15

30

3 mos

6 mos

MPS VII

$300,000

6MWT (meters)

10

45

6 mos

6 mos

Urinary GAG (μg/mg creatinine)

6

12

3 mos

6 mos

GM1 Gangliosidosis

$120,000

Mullen Scales of Early Learning (MSEL)

20

127

6 mos

1 yr

CSF GM1 ganglioside (pmol/ml)

15

30

3 mos

6 mos

LINCL

$200,000

Modified Hamburg LINCL clinical rating scale

10

30

6 mos

1 yr

CSF neurofilament protein (ng/L)

15

30

3 mos

6 mos

MLD

$200,000

MSEL

20

127

6 mos

1 yr

CSF sulfatide (nmol/L)

10

30

3 mos

6 mos

MPS IIIA

$200,000

MSEL

20

127

6 mos

1 yr

CSF MPS (heparan sulfate)

10

30

3 mos

6 mos

Niemann-Pick B

$300,000

Forced vital capacity (FVC %)

10

30

6 mos

6 mos

Liver size (% change in liver size by MRI)

10

30

6 mos

6 mos

LAL Deficiency

$300,000

Survival

15

30

6 mos

1.5 yrs

Liver size (% change in liver size by MRI)

10

30

6 mos

6 mos

Primary Hyperoxaluria

$300,000

Renal failure

20

183

6 mos

2 yrs

Urinary oxalate (mg/1.73 m²/day)

10

20

3 mos

6 mos

RDEB

$300,000

Hospitalizations

20

61

6 mos

1 yr

Number of anchoring fibrils over 2 × 25 μm of lamina densa

10

30

3 mos

6 mos

X-Linked HED

$100,000

Episodes of severe illness

20

87

6 mos

1 yr

First molar tooth bud presence

10

54

6 mos

6 mos

CDG-Ib

$50,000

Thrombosis

10

30

6 mos

1 yr

Antithrombin III (%)

6

12

6 mos

6 mos

  1. The table shows the diseases, the estimated cost of therapy, and endpoint and study design information; clinical and surrogate sample size and time to see effect values, and is based on references 12-39 and authors' expertise, as described in Methods. Clinical endpoints were chosen from successful development programs (6 minute walk test (6MWT) [13]), or well-accepted clinical problems (renal failure, hospitalizations, or developmental testing), often indicative of a disease's most severe aspect. We chose surrogate endpoints that directly reflected the disease state, and for which the pathologic mechanism was clear; some surrogates were selected for their conceptual link to a chosen clinical endpoint. These surrogates include urinary or CSF substrate accumulation, measures of tissue injury, or alteration in major organs.