Economic evaluation of oral Nirmatrelvir/ritonavir versus best supportive care in patients at high risk for progression to severe COVID-19 in Germany: a cost-effectiveness analysis.

Aim: To estimate the cost-effectiveness of Nirmatrelvir/ritonavir (NMV/r) versus best supportive care (BSC) in patients at high-risk for progression to severe COVID-19 from a German health payer perspective.

Methods: A closed cohort static model of 1,000 COVID-19 patients capturing the short-term (<1 year) via decision-tree and long-term (lifetime) outcomes via Markov model was used to assess the cost-effectiveness of NMV/r versus BSC. Model inputs were derived from the EPIC-HR clinical trial and published contemporary real-world data. Probabilistic and deterministic sensitivity analyses (PSA, DSA) were conducted to test the robustness of model results.

Results: In the base case, treatment with NMV/r versus BSC reduced COVID-19 related hospitalisations (-0.042), intensive care unit admissions (-0.006) and inpatient deaths (-0.003), while increasing life-years (LY) (0.047) per patient, which results in an incremental cost-effectiveness ratio of 10,845 € per hospitalisation avoided and 9,773 € per LY gained. Sensitivity analysis suggests the magnitude of the benefits increased with increasing hospitalisation risk. NMV/r emerged as the dominant strategy in a population with a hospitalisation risk equivalent to 60 years and older. Outcomes were similar with real world effectiveness data. DSA showed the model was most sensitive to hospitalisation and inpatient mortality risk, NMV/r medication cost and efficacy/effectiveness of NMV/r in reducing hospitalisation. PSA confirmed the robustness of the model results.

Limitations: As COVID-19 is a dynamic disease, caution should be taken in generalizing these results. Contemporary data is essential to ensure the model inputs and the outcomes remain relevant as there may be changes in natural disease course or effectiveness of NMV/r.

Conclusions: This cost-effectiveness analysis of NMV/r treatment from a German healthcare payer perspective demonstrates how by preventing progression to severe COVID-19, NMV/r reduces healthcare resource use, associated costs and preserves LY of patients. This analysis provides crucial economic rationale for decision making by policy makers.