Implications of COVID-19 Treatment Post-Pandemic: The Bulgarian Perspective

OBJECTIVES: As of May 2024, the Bulgarian COVID-19 information portal reports 1,339,945 confirmed cases, with 8,117 currently active (0.13% prevalence). Although a range of treatments have been developed for patients, supportive care is primarily used in patients who have already progressed to severe disease. An unmet need for a drug treating moderate to severe COVID-19 exists.

METHODS: To perform the cost-effectiveness and cost-utility analyses in adults, a cost-effectiveness model (CEM), consisting of a decision tree and Markov model over a lifetime horizon, was used. For paediatric patients, clinical data were used to calculate the average cost effectiveness ratio (ACER). The budget impact analysis (BI) for the next five years was performed using a Microsoft Excel model and data from the Bulgarian COVID-19 information portal. The perspective of all analyses is the payer: National Health Insurance Fund (NHIF).

RESULTS: Reimbursing the antiviral drug will cost BGN 20,484,042.86 for adults with pneumonia requiring oxygen, BGN 4,297,247.67 for adults with pneumonia not requiring oxygen, BGN 4,815,663.29 for paediatric patients with pneumonia requiring oxygen, and BGN 681,170.88 for paediatric patients with pneumonia not requiring oxygen, over five years. Despite the added costs, the CEM analysis reveals that drug increases health benefits by +2.82 LY of which+2.15 QALY per adult without oxygen requirement and by +2.45 LY, of which+1.87 QALY per adult with oxygen requirement, compared to the standard of care. The drug is considered cost-effective for adults both with and without oxygen needs. It is also cost-effective for the paediatric population, reducing the need for mechanical and non-invasive ventilation, as well as decreasing COVID-19 related hospitalization and mortality rates.

CONCLUSIONS: Despite the incurred costs, reimbursing the drug would improve health outcomes and decrease the need for assisted ventilation, reducing hospitalisation costs for NHIF. The analyses demonstrate results from one country part of CEE.