Iron deficiency (ID) is comorbid in up to 50% patients with heart failure (HF) and exacerbates disease burden. Ferric carboxymaltose (FCM) reduced HF hospitalizations and improved quality of life when used to treat ID at discharge in patients hospitalized for acute HF with left ventricular ejection fraction <50% in the AFFIRM-AHF trial. We quantified the effect of FCM on burden of disease and the wider pharmacoeconomic implications

Background SARS-CoV-2 (COVID-19) virus is estimated to cost the United States (US) economy trillions of dollars over the next decade. Mass immunization has played a major role in reducing morbidity and mortality related to COVID-19 in the US, but the high-risk population remains vulnerable to developing severe COVID-19. A large clinical trial and several real-world evidence (RWE) studies have demonstrated the effectiveness of nirmatrelvir; ritonavir in reducing hospitalizations or death in high-risk patients. This study aimed to estimate the economic impact of using nirmatrelvir; ritonavir in a high-risk US population infected with COVID-19 as measured by reduction in hospitalizations and associated costs during a time of Omicron predominance. Methods An economic model was developed to estimatethe impact of nirmatrelvir; ritonavir in reducing hospitalizations and associated costs from a healthcare perspective. The model compared nirmatrelvir; ritonavir with no treatment in the outpatient setting among patients with mild-to-moderate COVID-19 at high-risk of progressing to severe disease as consistent with the EPIC-HR trial. Hospitalization rate reductions were derived from recent RWE studies conducted during the Omicron period while costs were gathered from the literature. A simulated population of 100,000 COVID-19 patients was modelled and was restricted to patients ≥12 years of age. Sensitivity analyses applied alternative model assumptions. Results Results from the model showed that treatment with nirmatrelvir; ritonavir was associated with fewer hospitalizations compared to no treatment, 3,269 vs 6,134 per 100,000 patients, respectively, with a reduction of 2,865 hospitalizations per 100,000 patients and an estimated cost savings of $133,754,359 per 100,000 patients ($152,634,256 for nirmatrelvir; ritonavir and $286,388,614 for no treatment). Varying the rate of hospitalization by 10% showed similar results. Conclusion Treatment with nirmatrelvir; ritonavir during the Omicron period could result in substantial cost savings due to reduction in hospitalizations. This is an important outcome measure that will help reduce the devastating economic burden that COVID-19 has imposed on the US health care system.

Introduction Current antiretroviral therapies (ARTs) have improved outcomes for people living with HIV. However, the requirement to adhere to lifelong daily oral dosing may be challenging for some people living with HIV, leading to suboptimal adherence and therefore reduced treatment effectiveness. Treatment with long-acting (LA) ART may improve adherence and health-related quality of life. The objective of this study was to evaluate the cost-effectiveness of cabotegravir + rilpivirine (CAB+RPV) LA administered every 2 months (Q2M) compared with current ART administered as daily oral single-tablet regimens (STRs) from a Spanish National Healthcare System perspective. Methods A hybrid decision-tree and Markov state-transition model was used with pooled data from three phase III/IIIb trials (FLAIR, ATLAS, and ATLAS-2M) over a lifetime horizon, with health states defined by viral load and CD4 + cell count. Direct costs (in €) were taken from Spanish public sources from 2021 and several deterministic and probabilistic analyses were carried out. An annual 3% discount rate was applied to both costs and utilities. Results Over the lifetime horizon, CAB+RPV LA Q2M was associated with an additional 0.27 quality-adjusted life years (QALYs) and slightly greater lifetime costs (€4003) versus daily oral ART, leading to an incremental cost-effectiveness ratio of €15,003/QALY, below the commonly accepted €30,000/QALY willingness-to-pay threshold in Spain. All scenario analyses showed consistent results, and the probabilistic sensitivity analysis showed cost-effectiveness compared with daily oral STRs in 62.4% of simulations, being dominant in 0.3%. Conclusion From the Spanish National Health System perspective, CAB+RPV LA Q2M is a cost-effective alternative compared with the current options of daily oral STR regimens for HIV treatment. Clinical Trials Registration ATLAS, NCT02951052; ATLAS-2M, NCT03299049; FLAIR, NCT02938520. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-023-00840-y.

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