期刊
OPEN FORUM INFECTIOUS DISEASES
卷 9, 期 12, 页码 -出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/ofid/ofac637
关键词
COVID-19; allocation; cost-effectiveness; nirmatrelvir; ritonavir
资金
- National Institute on Drug Abuse DP2
- [DA049282]
- [DA15612]
This study conducted a cost-effectiveness analysis of prescription policy strategies for nirmatrelvir/ritonavir using a decision-analytic model. The results suggest that providing this drug to unvaccinated high-risk patients is cost-effective. The cost-effectiveness of other allocation strategies depends on various factors.
Background New coronavirus disease 2019 (COVID-19) medications force decision-makers to weigh limited evidence of efficacy and cost in determining which patient populations to target for treatment. A case in point is nirmatrelvir/ritonavir, a drug that has been recommended for elderly, high-risk individuals, regardless of vaccination status, even though clinical trials have only evaluated it in unvaccinated patients. A simple optimization framework might inform a more reasoned approach to the trade-offs implicit in the treatment allocation decision. Methods We conducted a cost-effectiveness analysis using a decision-analytic model comparing 5 nirmatrelvir/ritonavir prescription policy strategies, stratified by vaccination status and risk for severe disease. We considered treatment effectiveness at preventing hospitalization ranging from 21% to 89%. Sensitivity analyses were performed on major parameters of interest. A web-based tool was developed to permit decision-makers to tailor the analysis to their settings and priorities. Results Providing nirmatrelvir/ritonavir to unvaccinated patients at high risk for severe disease was cost-saving when effectiveness against hospitalization exceeded 33% and cost-effective under all other data scenarios we considered. The cost-effectiveness of other allocation strategies, including those for vaccinated adults and those at lower risk for severe disease, depended on willingness-to-pay thresholds, treatment cost and effectiveness, and the likelihood of severe disease. Conclusions Priority for nirmatrelvir/ritonavir treatment should be given to unvaccinated persons at high risk of severe disease from COVID-19. Further priority may be assigned by weighing treatment effectiveness, disease severity, drug cost, and willingness to pay for deaths averted.
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