Cost-Effectiveness Analysis of Molnupiravir Versus Best Supportive Care for the Treatment of Outpatient COVID-19 in Adults in the US

Abstract

Background and aims Coronavirus disease 2019 (COVID-19) imposes a substantial and ongoing burden on the US healthcare system and society. Molnupiravir is a new oral antiviral for treating COVID-19 in outpatient settings. This study evaluated the cost-effectiveness profile of molnupiravir versus best supportive care in the treatment of adult patients with mild-tomoderate COVID-19 at risk of progression to severe disease, from a US payer's perspective. Methods The model was developed using a decision tree for the short-term acute phase of COVID-19 and a Markov state transition model for the long-term post-acute phase. This model compared molnupiravir with best supportive care as consistent with the MOVe-OUT trial. Costs were reported in 2021 US dollars. Transition probabilities were derived from the phase III MOVe-OUT trial and the TriNetX real-world electronic health records database. Costs were derived from the TriNetX database and utility values from a de novo, vignette-based utility study. Deterministic and probabilistic sensitivity analyses (DSA/PSA) were conducted. Primary outcomes included proportion hospitalized, proportion who died overall and by highest healthcare setting at the end of the acute phase, quality-adjusted life-years (QALYs), and incremental costs per QALY gained over a lifetime (100 years) horizon, discounted at 3% annually and assessed at a willingness-to-pay (WTP) threshold of $100,000 per QALY. ResultsIn this model, the use of molnupiravir led to an increase in QALYs (0.210) and decrease in direct total medical costs (−$895) per patient across a lifetime horizon, compared with best supportive care in COVID-19 outpatients. Molnupiravir was the dominant intervention when compared with best supportive care. Patients treated with molnupiravir were less likely to be hospitalized (6.38% vs. 9.20%) and more likely to remain alive (99.88% vs. 98.71%) during the acute phase. Through DSA, molnupiravir treatment effect of hospitalization reduction was identified to be the most influential parameter, and through PSA, molnupiravir remained dominant in 84% of the total simulations and, overall, 100% cost effective. Conclusion This analysis suggests that molnupiravir is cost effective compared with best supportive care for the treatment of adult outpatients with COVID-19. However, our study was limited by the unavailability of the most recent information on the rapidly evolving pandemic, including new viral variants, patient populations affected, and changes in standards of care. Further research should explore the impact of vaccination on the cost effectiveness of molnupiravir and other therapies, based on real-world data, to account for these changes, including the impact of vaccination and immunity.

Early Treatment with Fluvoxamine among Patients with COVID-19: A Cost-Consequence Model

“…However, as with all trials, the demographic and disease characteristics of the population enrolled may differ from those seen in other health systems, particularly in terms of vaccination status. As noted in a recent analysis of another COVID-19 treatment, molnupiravir, 13 COVID-19 studies are inherently challenged by the evolution of the pandemic, particularly in relation to new viral strains and variability in SOC. However, subgroup analyses of the TOGETHER trial uniformly demonstrate favorable results for fluvoxamine, suggesting that heterogeneity of patient characteristics is unlikely to undermine the validity of the conclusions of this analysis, though further study of alternative SOC models is warranted.…”

“… 12 However, the approach differs from a recent analysis of molnupiravir, which used reduced rates of care escalation for treated patients based on post hoc analyses of the trial data. 13 …”

“…12 However, the approach differs from a recent analysis of molnupiravir, which used reduced rates of care escalation for treated patients based on post hoc analyses of the trial data. 13 Clinical and economic data used in the model are reported in Table 1. All costs were inflated to 2021 U.S. dollars, using the Medical Care Inflation Calculator.…”

Drug treatment of COVID-19 infection

“…Cost-effectiveness analyses from Hong Kong and USA analysing data from large electronic health databases showed that the use of SARS-CoV-2 oral antivirals, vs. symptomatic care, in outpatient setting reduced healthcare costs and increased quality-adjusted life years, by reducing subsequent hospital admissions, readmissions and long-term sequelae [ 12 , 20 ].…”

Therapeutic potential of compounds targeting SARS-CoV-2 helicase

“…Being a repurposed drug, fluvoxamine, which was first approved by the FDA in 1994 (trade name: Luvox), has the advantage of decades of safety data surrounding its use. Unlike molnupiravir and paxlovid where a treatment course costs approximately 700 and 500 USD, respectively ( Goswami et al, 2022 ; Morrison Ponce et al, 2022 ), fluvoxamine is accessible at 4 USD per course ( Wang et al, 2021 ). Remdesivir is also expensive at over 2000 USD per 5-day treatment course ( Carta and Conversano, 2021 ).…”