Insights From Economic Evaluations in Emerging Infection Diseases in France: Focus on COVID-19

OBJECTIVES: The emergence of COVID-19 in 2020 has created a real disruption in the timing of market access and data production. Vaccines and treatments have been developed in just a few months. This situation has simultaneously generated clinical interest, reflected in published literature and the development of multiple data collection networks.

Although the french HTA (HAS) was involved at an early stage in treatment recommendations, the first COVID-19 related drug to be assessed by the French Economic and Public Health Assessment Committee (CEESP) was Xevudy in October 2022. Since then, the CEESP has published 3 others’ opinions (Paxolvid and two for Evusheld).

The aim of this article is to review the different economic opinions and discuss how to produce relevant economic information in the context of an emerging infectious disease.

METHODS: Using Vyoo Agency efficiency database, all CEESP opinions for COVID-19 related drugs have been reviewed. The structural and modelling choices of these analysis and CEESP’s conclusions were compared.

RESULTS: The CEESP assessed four economic evaluations on COVID-19. The major critiques in all assessments were the lack of reinfection modelling and the heterogenous utility data-from infection to long-COVID. Despite data input in the economic evaluations were different (ie.long covid rate), sensitivity analysis based on real-world evidence data or literature showed consistent impact on the results/conclusions. Also, the CEESP have very similar decision despite variability in the number of reservations (i.e. minor/medium). However, the main reason for all rejections by CEESP was the uncertainty in clinical efficacy from the drugs going forward based on evolving variants.

CONCLUSIONS: Whereas Transparency Commission formulated conditional conclusions based on variant´s sensitivity, CEESP’s conclusion was to disregard and rejected all economic information. Considering available data and the capacity of modelling to explore uncertainty, an ICER range based on clinical context changes could be relevant to produce relevant economic information.