Association of Molnupiravir and Nirmatrelvir-Ritonavir with preventable mortality, hospital admissions and related avoidable healthcare system cost among high-risk patients with mild to moderate COVID-19

Wai, Abraham Ka Chung; Chan, Crystal; Cheung, Asy; Wang, Kailu; Chan, Sunny Ching-Long; Lee, Teddy Tai-Loy; Luk, Luke Yik-fung; Yip, Edmond Tsz-Fung; Ho, Joshua W. K.; Tsui, Omar Wai-Kiu; Cheung, Kelly Wing-Yin; Lee, Shiyeow; Tong, Chak-kwan; Yamamoto, Tafu; Rainer, Timothy; Wong, Eliza Lai-Yi

doi:10.1016/j.lanwpc.2022.100602

Cited by 65 publications

(113 citation statements)

References 17 publications

(18 reference statements)

Supporting

Mentioning

102

Contrasting

Unclassified

Order By: Relevance

“…While each drug appeared to provide benefit to either hospitalization or death, no data was available specific to advanced age. Molnupiravir patients tended to have a higher incidence of renal disease in one study, and in the other study these patients were older and less likely to be vaccinated 25 , 26 . Similarly, a small observational study attempted to directly compare outcomes of patients treated with molnupiravir versus those treated with nirmatrelvir/ritonavir 27 .…”

Section: Discussionmentioning

confidence: 79%

Characteristics and outcomes of US Veterans at least 65 years of age at high risk of severe SARS-CoV-2 infection with or without receipt of oral antiviral agents

Gentry

Nguyen

Thind

et al. 2023

Journal of Infection

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 79%

Characteristics and outcomes of US Veterans at least 65 years of age at high risk of severe SARS-CoV-2 infection with or without receipt of oral antiviral agents

Gentry

Nguyen

Thind

et al. 2023

Journal of Infection

View full text Add to dashboard Cite

“…Centralised electronic health records from the Clinical Data Analysis and Reporting System (CDARS) were evaluated for patient identification and data extraction. This system has been used previously by our team and other teams for healthcare resource utilisation and cost analysis for catecholaminergic polymorphic ventricular tachycardia (CPVT) (10), cancer patients receiving immunotherapy (11), and COVID-19 (12, 13). The diagnosis of LQTS and BrS was made initially by case physicians and was further verified by G.T.…”

Section: Methodsmentioning

confidence: 99%

Comparisons of healthcare resource utilisation and costs between Brugada syndrome and congenital long QT syndrome: a territory-wide study

Lee¹,

Chung²,

Radford

et al. 2022

Preprint

View full text Add to dashboard Cite

Introduction: Healthcare resource utilisation and costs are important metrics of healthcare burden, but they have rarely been explored in the setting of cardiac ion channelopathies. Purpose: The aim of this study is to compare HCRUs and costs between patients with Brugada syndrome (BrS) and congenital long QT syndrome (LQTS) in a single city of China. Methods: This was a territory-wide retrospective cohort study of consecutive BrS and LQTS patients at public hospitals or clinics in Hong Kong, China. HCRUs and costs (in USD) for accident and emergency (A&E), inpatient, general outpatient and specialist outpatient attendances were analysed over a 19-year period (2001-2019) at the cohort level. Comparisons were made between BrS and LQTS cohorts using incidence rate ratios (IRRs [95% confidence intervals]). Results: Over the 19-year study period, 516 BrS (median age of initial presentation: 51 [interquartile range: 38-61] years, 92% male) and 134 LQTS (median age of initial presentation: 21 [9-44] years, 32% male) patients were included. BrS patients had lower total costs compared to LQTS patients (2,008,126 [2,007,622-2,008,629] vs. 2,343,864 [2,342,828-2,344,900]; IRR: 0.857 [0.855-0.858]). For specific attendance types, BrS patients had higher costs for A&E attendances (83,113 [83,048-83,177] vs. 70,604 [70,487-70,721]; IRR: 1.177 [1.165-1.189]) and general outpatient services (2,176 [2,166-2,187] vs. 921 [908-935]; IRR: 2.363 [2.187-2.552]). However, they had lower costs for inpatient stay (1,391,624 [1,391,359-1,391,889] vs. 1,713,742 [1,713,166-1,714,319]; IRR: 0.812 [0.810-0.814]) and to a smaller extent, lower costs for specialist outpatient services (531213 [531049-531376] vs. 558597 [558268-558926]; IRR: 0.951 [0.947-0.9550]) compared to LQTS patients. Conclusion: Overall, BrS patients consume 14% less healthcare resources compared to LQTS patients in terms of attendance costs. BrS patients require more A&E and general outpatient services, but less inpatient and specialist outpatient services than LQTS patients. Further studies are needed to examine patient-based attendances and costs to identify subgroups of high HCRU users for both cohorts.

show abstract

“…Real-world experience with nirmatrelvir plus ritonavir supports the efficacy results observed during the EPIC-HR trial [ 14 – 20 ]. Reductions in the risk of severe COVID-19 [ 17 ], mortality [ 15 – 19 ], hospitalization [ 14 – 16 , 19 , 20 ] and disease progression (mortality, invasive mechanical ventilation or intensive care unit admission) [ 15 , 18 ] were reported across studies in Hong Kong [ 15 , 18 , 19 ], Israel [ 16 , 17 ] and the USA [ 14 , 20 ] that each included ≥ 1000 patients treated with nirmatrelvir plus ritonavir.…”

Section: What Is the Efficacy Of Nirmatrelvir Plus Ritonavir In Covid...mentioning

confidence: 99%

“…High epidemic resurgence of COVID-19 is expected to have a considerable burden on health system capacity [ 29 ]. In Hong Kong, both nirmatrelvir plus ritonavir and molnupiravir were associated with significant cost savings [ 19 ]. In the outpatient setting, nirmatrelvir plus ritonavir cost $US331,105 to prevent one death, but saved $US5,503 to prevent one death relative to standard care [ 19 ].…”

Section: What Is the Current Clinical Role Of Nirmatrelvir Plus Riton...mentioning

confidence: 99%

“…In Hong Kong, both nirmatrelvir plus ritonavir and molnupiravir were associated with significant cost savings [ 19 ]. In the outpatient setting, nirmatrelvir plus ritonavir cost $US331,105 to prevent one death, but saved $US5,503 to prevent one death relative to standard care [ 19 ]. In Korea, treatment of symptomatic COVID-19 with oral nirmatrelvir plus ritonavir is likely to be cost effective, with incremental cost-effectiveness ratios (ICERs) of $US8878, $US8964 and $US1454 per prevented severe case when targeting all adults, adults with underlying diseases and elderly patients, respectively [ 29 ].…”

Section: What Is the Current Clinical Role Of Nirmatrelvir Plus Riton...mentioning

confidence: 99%

See 1 more Smart Citation

Nirmatrelvir plus ritonavir in COVID-19: a profile of its use

Blair

2022

Drugs Ther Perspect

View full text Add to dashboard Cite

Oral nirmatrelvir plus ritonavir (Paxlovid ™ ) is an effective treatment option for coronavirus disease 2019 (COVID-19), the illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nirmatrelvir inhibits the main protease of SARS-CoV-2, with ritonavir acting as a pharmacokinetic booster. In the phase II/III EPIC-HR trial, nirmatrelvir plus ritonavir reduced the risk of progression to severe COVID-19 in symptomatic, unvaccinated, non-hospitalized adults with mild-to-moderate COVID-19 at high risk for progression to severe disease. The incidence of COVID-19-related hospitalization or death through day 28 was significantly lower with nirmatrelvir plus ritonavir than with placebo. The efficacy of nirmatrelvir plus ritonavir has also been demonstrated in the real-world setting. Nirmatrelvir plus ritonavir is generally well tolerated, with most adverse events being of mild or moderate severity. Supplementary Information The online version contains supplementary material available at 10.1007/s40267-022-00971-1.

show abstract

Association of Molnupiravir and Nirmatrelvir-Ritonavir with preventable mortality, hospital admissions and related avoidable healthcare system cost among high-risk patients with mild to moderate COVID-19

Cited by 65 publications

References 17 publications

Characteristics and outcomes of US Veterans at least 65 years of age at high risk of severe SARS-CoV-2 infection with or without receipt of oral antiviral agents

Characteristics and outcomes of US Veterans at least 65 years of age at high risk of severe SARS-CoV-2 infection with or without receipt of oral antiviral agents

Comparisons of healthcare resource utilisation and costs between Brugada syndrome and congenital long QT syndrome: a territory-wide study

Nirmatrelvir plus ritonavir in COVID-19: a profile of its use

Contact Info

Product

Resources

About