To the Editor We read with interest the economic evaluation by Raymakers et al¹ estimating the cost of beremagene geperpavec (B-VEC) therapy for dystrophic epidermolysis bullosa (DEB). The authors conclude that US Food and Drug Administration (FDA) approval of B-VEC therapy for DEB will pose a significant cost to payers.

Although the analysis was thorough and the sensitivity analyses accounted for reasonable assumptions affecting drug costs, it is also important to consider reductions in health care expenditure resulting from B-VEC treatment. Direct costs are expected to decrease for patients receiving B-VEC, such as the costs of medical appointments, allied health services, and consumables such as dressings. Autosomal recessive dystrophic epidermolysis bullosa (RDEB), the most severe form of DEB, is associated with several complications. These sequelae are expected to decrease with B-VEC (eg, squamous cell carcinoma), thereby reducing costs.² Indirect costs, such as reduction or cessation of work by patients or caregivers, or travel costs may also be reduced. These omitted costs may offset a considerable proportion of the anticipated drug expenses, especially should B-VEC demonstrate long-term efficacy.