Real-world effectiveness and economic analysis of nirmatrelvir/ritonavir, remdesivir, and molnupiravir for treatment of COVID-19 among ambulatory patients in Thailand

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-05-13 DOI:10.1016/j.jiph.2025.102826

Sirapat Korwiwattanakan , Surangkana Samanloh , Pinyo Rattanaumpawan

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引用次数: 0

Abstract

Background

Nirmatrelvir/ritonavir, remdesivir, and molnupiravir are recommended antiviral therapies for non-severe COVID-19 patients at high risk of disease progression. This study evaluated the real-world effectiveness and economic impact of these three antiviral regimens in Thailand.

Methods

This retrospective observational study was conducted at Siriraj Hospital, Thailand. Eligible patients were ambulatory adults (≥15 years old) with non-severe COVID-19 infection, presenting ≥1 risk factor for disease progression, and receiving ≥1 dose of nirmatrelvir/ritonavir, remdesivir, or molnupiravir within 5 days of symptom onset. Subsequently, an economic analysis was performed using data from this study and landmark clinical trials.

Findings

During the study period (March-August 2022), there were 374 eligible patients: 104 patients (30.0 %), 114 patients (33.0 %), and 127 patients (37.0 %) received nirmatrelvir/ritonavir, remdesivir, and molnupiravir, respectively. The unfavorable clinical outcomes were significantly higher in the remdesivir group (12.28 %), compared to the nirmatrelvir/ritonavir group (2.88 %), and the molnupiravir group (4.72 %) by pairwise comparison (p-value<0.001). After adjusting for significant comorbidities, no statistically significant difference in unfavorable clinical outcomes was observed among these comparison groups. Economic analysis utilizing the effectiveness of landmark trials under Thai economic data indicated that remdesivir was the preferred option over the other two antivirals. Nirmatrelvir/ritonavir would become the dominant option over remdesivir if its price were to decrease to $108.157 or less per treatment course.

Interpretation

Compared to other countries, our study found higher unfavorable outcomes in vaccinated individuals, but lower than previous Thai data. Treatment effects were similar across groups. Our economic analysis favored remdesivir.

查看原文本刊更多论文

nirmatrelvir/ritonavir、remdesivir和molnupiravir治疗泰国流动患者COVID-19的实际有效性和经济分析

背景nirmatrelvir /ritonavir、remdesivir和molnupiravir是疾病进展高风险的非严重COVID-19患者的推荐抗病毒治疗药物。本研究评估了这三种抗病毒方案在泰国的实际有效性和经济影响。方法回顾性观察研究在泰国Siriraj医院进行。符合条件的患者为非严重COVID-19感染的流动成年人（≥15岁），存在≥1个疾病进展危险因素，并在症状出现后5天内接受≥1剂量的尼马特利韦/利托那韦、瑞德西韦或莫努匹拉韦。随后，使用本研究和具有里程碑意义的临床试验的数据进行了经济分析。在研究期间（2022年3月至8月），有374名符合条件的患者：104名患者（30.0 %），114名患者（33.0 %）和127名患者（37.0 %）分别接受了nirmatrelvir/ritonavir， remdesivir和molnupiravir。两两比较，瑞德西韦组的不良临床结果（12.28 %）明显高于尼马特利韦/利托那韦组（2.88 %）和莫诺匹拉韦组（4.72 %）（p值<；0.001）。在调整了显著合并症后，在这些对照组中观察到的不良临床结果没有统计学上的显著差异。利用泰国经济数据下具有里程碑意义的试验的有效性进行的经济分析表明，瑞德西韦是其他两种抗病毒药物的首选。如果尼马特瑞韦/利托那韦的每疗程价格降至108.157美元或更低，那么尼马特瑞韦/利托那韦将成为瑞德西韦的主要选择。与其他国家相比，我们的研究发现接种疫苗个体的不良后果较高，但低于泰国之前的数据。各组治疗效果相似。我们的经济分析倾向于瑞德西韦。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.