Abstract
Despite COVID-19’s significant morbidity and mortality, considering cost-effectiveness of pharmacologic treatment strategies for hospitalized patients remains critical to support healthcare resource decisions within budgetary constraints. As such, we calculated the cost-effectiveness of using remdesivir and dexamethasone for moderate to severe COVID-19 respiratory infections using the United States health care system as a representative model. 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 only moderate and only severe 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. Supportive care for moderate/severe COVID-19 cost $11,112.98 with 0.7155 quality adjusted life-year (QALY) obtained. Using dexamethasone for all patients was the most-cost effective with an incremental cost-effectiveness ratio of $980.84/QALY; all remdesivir strategies were more costly and less effective. Probabilistic sensitivity analyses showed dexamethasone for all patients was most cost-effective in 98.3% of scenarios. Dexamethasone for moderate-severe COVID-19 infections was the most cost-effective strategy and would have minimal budget impact. Based on current data, remdesivir is unlikely to be a cost-effective treatment for COVID-19.
Highlights
Despite COVID-19’s significant morbidity and mortality, considering cost-effectiveness of pharmacologic treatment strategies for hospitalized patients remains critical to support healthcare resource decisions within budgetary constraints
Using dexamethasone for all patients was associated with an incremental cost-effectiveness ratio (ICER) of $981/quality adjusted life-year (QALY) versus supportive care and an ICER of $1724/QALY as compared to using dexamethasone in only severe COVID-19 cases
Using a severity stratified treatment approach of remdesivir for moderate COVID-19 infections and dexamethasone for severe infections was dominated by the dexamethasone strategies
Summary
Despite COVID-19’s significant morbidity and mortality, considering cost-effectiveness of pharmacologic treatment strategies for hospitalized patients remains critical to support healthcare resource decisions within budgetary constraints. SARSCoV-2 has caused significant morbidity and mortality globally; as of May 21, 2021, there have been 165,705,287 documented cases worldwide and 3,434,082 confirmed deaths with the highest national burden far in the United States[2] Given this impact, there has been great interest in finding potential treatments for COVID-193 early enthusiasm and adoption of possible candidate drugs, such as hydroxychloroquine, has been tempered upon rigorous s tudy[4]. Despite the public health emergency with COVID-19, health care systems continue to need to operate within a budget and make resource allocation decisions As such, given this and the burden of COVID-19 in the United States, we developed a cost-effectiveness analysis of remdesivir and dexamethasone in the United States context with additional global considerations assessed by willingness-to-pay thresholds
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