NICE:

MARA rated targeted-release budesonide (Kinpeygo) A (Strong) before NICE published TA1128 on 4 February 2026. The A grade correctly predicted a positive access outcome — NICE recommended budesonide as add-on to optimised standard care for primary IgAN patients with proteinuria at or above the defined threshold, within a cost-effectiveness profile MARA assessed as strong (most likely ICER £4,672/QALY, well within NICE’s acceptable range). MARA’s Uncertainty domain was rated Strong with mild sensitivity; NICE flagged one structural limitation not explicitly captured — the NefIgArd trial standard care did not include DEARA or SGLT2i treatments now routinely used in the NHS, creating model uncertainty the committee accepted but noted. The conditional recommendation (proteinuria threshold and prior RASi optimisation required) reflects a clinically defined patient restriction consistent with MARA’s Patient Population assessment.

HAS:

MARA rated targeted-release budesonide (Kinpeygo) A (Strong) before HAS published CT opinion CT21450 on 4 March 2026. The A grade correctly predicted reimbursement — HAS concluded SMR Important for adult IgAN patients with proteinuria ≥ 1.0 g/day after RASi optimisation, and ASMR IV (minor added benefit), consistent with MARA’s historical HAS signal that placed ASMR V at just 16% vs. a 59% baseline. Two domains MARA rated as Strong were explicitly limited by HAS: HRQoL evidence was classified as exploratory and non-prespecified in the statistical plan, and no direct comparison against systemic corticosteroids was available — both cited as primary reasons for not granting a higher ASMR level. The restriction to the proteinuria-defined population mirrors MARA’s Patient Population assessment of the evidence as tied to a defined high-risk group.