Estimated Impact of Oral Nirmatrelvir;Ritonavir on Reductions in Hospitalizations and Associated Costs within High-Risk COVID-19 Patients in the US

Abstract

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.

Key Considerations during the Transition from the Acute Phase of the COVID-19 Pandemic: A Narrative Review

“…It is pivotal to ensure their availability, particularly when an increased number of SARS-CoV-2 infections can be expected (e.g., during the autumn–winter season in the temperate zone). In this regard, oral antivirals are the pharmaceuticals of choice as they reduce healthcare costs through decreased hospitalization rates [ 200 , 201 , 202 ]. At the same time, it is important to pursue research on the potential benefits arising from therapies based on the combination of antivirals, assessed mostly as case reports [ 203 ] or in vivo rodent studies [ 204 ].…”