Abstract
Remdesivir and dexamethasone are the only drugs providing reductions in the lengths of hospital stays for COVID-19 patients. We assessed the impacts of remdesivir on hospital-bed resources and budgets affected by the COVID-19 outbreak. A stochastic agent-based model was combined with epidemiological data available on the COVID-19 outbreak in France and data from two randomized control trials. Strategies involving treating with remdesivir only patients with low-flow oxygen and patients with low-flow and high-flow oxygen were examined. Treating all eligible low-flow oxygen patients during the entirety of the second wave would have decreased hospital-bed occupancy in conventional wards by 4% [2%; 7%] and intensive care unit (ICU)-bed occupancy by 9% [6%; 13%]. Extending remdesivir use to high-flow-oxygen patients would have amplified reductions in ICU-bed occupancy by up to 14% [18%; 11%]. A minimum remdesivir uptake of 20% was required to observe decreases in bed occupancy. Dexamethasone had effects of similar amplitude. Depending on the treatment strategy, using remdesivir would, in most cases, generate savings (up to 722€) or at least be cost neutral (an extra cost of 34€). Treating eligible patients could significantly limit the saturation of hospital capacities, particularly in ICUs. The generated savings would exceed the costs of medications.
Highlights
The most prominent burden of the COVID-19 outbreak in France is the saturation of hospital resources due to the massive influx of COVID-19 patients at hospital
On the day of the peak, using remdesivir would have resulted in a 6% lower hospital-bed occupancy in the conventional ward in both scenarios (33,500 vs 35,650 hospital beds occupied in France on the 18/11/2020, or 50.0 vs 53.2 per 100,000 inhabitants)
We showed that the use of remdesivir would have a significant impact on hospital- and ICUbed occupancy, even when administered only to patients with low-flow-oxygen therapy
Summary
The most prominent burden of the COVID-19 outbreak in France is the saturation of hospital resources due to the massive influx of COVID-19 patients at hospital. Non-pharmaceutical interventions (NPIs) have been shown to be effective in containing the spread of the outbreak. No pharmaceutical drugs with proven efficacy in containing the spread of SARSCoV-2 were available at the early phase of the pandemic. Most public health policies initially consisted of NPIs aimed at “flattening the curve” (ranging from physical distancing to school closures and full lockdowns) to avoid. Impact of remdesivir and dexamethasone on hospital-bed resources and budget
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