Treatment of Moderate to Severe Respiratory COVID-19—A Cost-Utility Analysis

Abstract

Background: Due to COVID-19's significant morbidity and mortality, identifying the most cost-effective pharmacologic treatment strategy is critical. As such, we determined the most cost-effective strategy for moderate to severe COVID-19 respiratory infections using the United States health care system as a representative model. Methods: A decision analytic model modelled a base case scenario of a 60-year-old patient admitted to hospital with COVID-19. Patients requiring oxygen were considered moderate severity, and patients with severe COVID-19 required intubation with intensive care. Strategies modelled included giving remdesivir to all patients, remdesivir in severe infections, remdesivir in moderate infections, dexamethasone to all patients, dexamethasone in severe infections, remdesivir in moderate/dexamethasone in severe infections, and best supportive care. Data for the model came from the published literature. The time horizon was 1 year; no discounting was performed due to the short duration. The perspective was of the payer in the United States health care system. Results: Supportive care for moderate/severe COVID-19 cost $11,112.98/0.8256 QALY. Remdesivir in moderate/dexamethasone in severe infections was the most cost-effective with an incremental cost-effectiveness ratio of $19,764.56/QALY gained compared to supportive care. Probabilistic sensitivity analyses showed remdesivir for moderate/dexamethasone for severe COVID-19 infection was most cost-effective in 88.6% of scenarios and dexamethasone in moderate-severe infections in 11.4% of scenarios. With lower willingness to pay thresholds ($250-$37,500), dexamethasone for severe infections was favoured. Conclusions: Remdesivir for moderate/dexamethasone for severe COVID-19 infections was the most cost-effective strategy. Further data is required for remdesivir to better assess its cost effectiveness in treatment of COVID-19.

A Cost-Effectiveness Analysis of Remdesivir for the Treatment of Hospitalized Patients With COVID-19 in England and Wales

“…Results are not directly comparable with other published economic evaluation for RDV [30][31][32] given that there are a number of important differences in terms of population considered, comparators, methodology, and evidence used. Previous published economic evaluations [30][31][32] at the time this analysis was conducted used a decision-tree approach with patients considered either recovered or dead during the first month, followed by a Markov model or payoff. The population included in previous economic evaluations [30][31][32] was also broader including patients not on oxygen or on invasive ventilation at the start of treatment.…”

“…Previous published economic evaluations [30][31][32] at the time this analysis was conducted used a decision-tree approach with patients considered either recovered or dead during the first month, followed by a Markov model or payoff. The population included in previous economic evaluations [30][31][32] was also broader including patients not on oxygen or on invasive ventilation at the start of treatment. This differs from the licensed indication for RDV in Europe, which specifies patients with pneumonia requiring supplemental oxygen.…”

“…In Campbell et al 30 (2020) for instance, hospitalization costs are calculated based on the oxygen support required as highest level of respiratory support (one-off cost not based on duration of hospitalization) and are disconnected from the starting health state and therefore only applicable for the overall ACTT-1 population. Compared with previous economic evaluations, [30][31][32] our model further considers that COVID-19 patients are, on average, at an elevated risk of death, reduced QOL, and multiorgan dysfunctions after discharge. None of these effects were included in previous published economic evaluations at the time this analysis was conducted.…”

“…None of these effects were included in previous published economic evaluations at the time this analysis was conducted. [30][31][32] As with any economic evaluation, there are limitations to be acknowledged. First, any economic evaluation for COVID-19 is challenging to conduct because of the rapidly changing environment.…”

Approximate Bayesian Computation for an Explicit-Duration Hidden Markov Model of COVID-19 Hospital Trajectories

“…We have identified three. Congly et al (2020) evaluated the administration of either remdesivir or dexamethasone to various groups of patients hospitalized to treat their COVID 19 infections. Assumptions for the model came from the literature.…”