Budget Impact of Oral Nirmatrelvir/Ritonavir in Patients at High Risk for Progression to Severe COVID-19 in the US

Speaker(s)

Sandin R1, Veenstra D2, Dzingina M3, Vankelegom M4, Sullivan S2, Campbell D5, Ma C4, Harrison C4, Draica F6, Wiemken TL6, Mugwagwa T7
1Pfizer AB, Stockholm, Sweden, 2Curta Inc, Seattle, WA, USA, 3Pfizer, London, LON, UK, 4Health Economics & Outcomes Research Ltd, Cardiff, UK, 5Curta Inc, South Kingstown, RI, USA, 6Pfizer Inc., New York, NY, USA, 7Pfizer Inc, New York, NY, USA

OBJECTIVES: Nirmatrelvir/ritonavir (NMV/r) is indicated for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who are at high risk for progression to severe COVID-19. NMV/r has also been authorized for emergency use by FDA for the treatment of mild-to-moderate COVID-19 in pediatric patients (12 years of age and older weighing at least 40 kg) who are at high risk for progression to severe COVID-19.

METHODS: A budget impact model was developed to assess the impact of NMV/r on healthcare costs in a hypothetical 1-million-member health plan over a 1-year period in the US. Population, clinical, and cost inputs were derived from published literature, focusing on the recent COVID-19 era of vaccinated patients and predominance of the Omicron variant. In the base-case it was assumed the only effect of NMV/r was a reduction in incidence (not severity) of hospitalization/death; its potential effect on post-COVID conditions (PCC) was assessed in a scenario analysis. Outcomes included the number of hospitalizations, total cost, per-member per-month (PMPM) costs, and annual cost per treated patient (PPPY). Sensitivity and scenario analyses were conducted to assess uncertainty around model inputs.

RESULTS: An estimated 37,499 patients were eligible for treatment with NMV/r over one year. NMV/r use was estimated to reduce the number of hospitalizations by 819 with a budget impact of $3,460,437, $0.29 PMPM and $92 PPPY. NMV/r was cost savings when including PCCs with a budget impact of -$1,912,380, -$0.16 PMPM and -$92 PPPY. Sensitivity analyses indicated results were most sensitive to the price of NMV/r, risk of hospitalization under supportive care, and risk of hospitalization with NMV/r treatment.

CONCLUSIONS: Treatment with NMV/r in the current COVID-19 era is estimated to result in substantial cost offsets due to reductions in hospitalization and modest budget impact to potential overall cost savings for US health plans.

Code

EE644

Topic

Economic Evaluation

Topic Subcategory

Budget Impact Analysis

Disease

Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas