Adding family spillover to the societal perspective counter-intuitively increased the incremental cost per QALY gained by #2% for nusinersen and #5% for OA-xioi in all curve selection strategies. Conclusions: Different long-term outcome modeling approaches yielded up to a 19% decrease in the incremental cost effectiveness, potentially large enough to influence policy decisions. Family spillover effects had a relatively small impact. Key limitations of this report included uncertainties around long-term clinical benefits and exclusion of caregiver impact in the economic evaluation.

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