Emma Birnie, Magda Vergouwe, Brent Appelman, Jason J Biemond, Jarom Heijmans, Brooke E Nichols, W Joost Wiersinga, Stephanie Popping
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引用次数: 0
Abstract
Background: To prevent severe disease, nirmatrelvir/ritonavir (nirmatrelvir/r) is administered to individuals infected with SARS-CoV-2 who are at high risk, and it is currently priced at approximately $1375 in the Netherlands. We aim to evaluate the health outcomes and cost-effectiveness of nirmatrelvir/r among patients with high risk of severe disease.
Methods: We used a decision-analytic model parameterized with clinical and health care utilization data from individuals at high risk who were infected with SARS-CoV-2 between September 2021 and November 2023. We assumed baseline event rates of 1% for hospitalization and 0.05% for intensive care unit admission. Nirmatrelvir/r-related factors were varied. Costs were collected from a third-party payer's perspective, and the cost-effectiveness threshold was <$88 000 per quality-adjusted life-year gained. Sensitivity analyses were performed to account for uncertainties.
Results: This study included 949 individuals at high risk who were infected with SARS-CoV-2. The sample had a median age of 65 years (IQR, 53-75), and 416 (44%) participants were female. Comorbidities included obesity (25%), hematologic malignancy (21%), solid organ/stem cell transplantation (17%), and immunosuppressive medication use (47%). With an assumed low effectiveness, nirmatrelvir/r could reduce hospitalizations and deaths (relative risk reduction, 21% and 44%, respectively). With high effectiveness, relative risk reductions of 89% and 90% were calculated for hospitalizations and deaths. Higher baseline rates for intensive care unit and hospital admission positively influenced cost-effectiveness thresholds. Nirmatrelvir/r is cost-effectively priced at <$512 with low effectiveness and <$1071 with high effectiveness.
Conclusions: With current low baseline event rates for hospitalization, nirmatrelvir/r has the potential, not only to reduce hospitalizations and deaths in individuals with COVID-19 who are at high risk, but to do so cost-effectively with a drug price reduction of 22% to 63%. These findings are relevant for policy makers and physicians and emphasize the importance of reevaluating current drug pricing.
期刊介绍：
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.
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