Amelioration of Indirect Costs Following COVID-19 Infection in High-Risk US Patients Treated With Nirmatrelvir-Ritonavir
Author(s)
Maria M. Fernandez, PhD1, Brenna L. Brady, PhD2, Kristin Evans, PhD2, Gurinder S. Sidhu, MD, MHA, MBA1, Paul Cislo, PhD1, Frank R. Ernst, PharmD, RPh MS1, Joseph C. Cappelleri, MPH, MS, PhD1, Mohammad A. Chaudhary, MSc, PhD1, Emmanuel F. Drabo, PhD3, Ruth Mokgokong, PhD1;
1Pfizer, New York, NY, USA, 2Merative, Ann Arbor, MI, USA, 3Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
1Pfizer, New York, NY, USA, 2Merative, Ann Arbor, MI, USA, 3Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
OBJECTIVES: Nirmatrelvir-ritonavir (NMV/r; Paxlovid) reduces hospitalization and death in high-risk patients with COVID-19 and has been associated with direct cost savings. However, potential benefits of treatment on productivity and indirect costs have not been assessed in the US. This retrospective cohort study compared employer indirect cost burdens derived from workplace absenteeism, short-term disability (STD), or long-term disability (LTD) between high-risk patients with COVID-19 who did or did not receive treatment with NMV/r.
METHODS: US adult employees at high-risk of severe disease with a COVID-19 diagnosis between 12/16/2021 and 12/1/2022 were selected in the MarketScan Health and Productivity Management Database and followed from 6 months prior through ≥30 days following index (first COVID-19 diagnosis). Treated patients had a NMV/r claim within 0-4 days following index and were directly matched (1:1) with untreated patients on age, sex, index quarter, Charlson Comorbidity Index score, and pre-index hospitalization/emergency room visit. Per-patient-per-month (PPPM) indirect costs (estimated by multiplying median 2022 wage by absence days or 70% of disability days) were calculated over the variable post-index period and reported as monthly costs per 1,000 employees.
RESULTS: The matched absence, STD, and LTD cohorts included 1,909, 20,065, and 20,318 treated and untreated patients, respectively. Over the median 5 months of follow-up, per 1,000 individuals, treated employees had lower monthly costs attributed to: absence ($434,120 vs. $468,377; -$34,257 [95%CI:-$66,460;-$1,540]), STD ($84,153 vs. $108,440; -$24,288 [95%CI:-$33,680;-$14,900]), and LTD ($4,390 vs. $7,350; -$2,960 [95%CI:-$5,800;-$120]) compared to untreated employees. Indirect cost savings for treated compared to untreated employees were greater within subsets of individuals with baseline chronic lung disease (absence:-$176,746 [95%CI:-$371,360;$17,360]; STD:-$34,227 [95%CI:-$110,430;$41,990]; LTD:-$27,467 [95%CI:-$57,620;$2,680]) or overweight/obesity (absence:-$98,073 [95%CI:-$156,790;-$41,210]; STD:-$26,329 [95%CI:-$45,020;-$7,640]; LTD:-$4,666 [95%CI:-$11,260;$2,020]).
CONCLUSIONS: Lower indirect costs observed in treated cohorts, especially among employees with comorbid conditions, indicate that NMV/r treatment may provide a societal benefit in addition to previously demonstrated direct healthcare benefits.
METHODS: US adult employees at high-risk of severe disease with a COVID-19 diagnosis between 12/16/2021 and 12/1/2022 were selected in the MarketScan Health and Productivity Management Database and followed from 6 months prior through ≥30 days following index (first COVID-19 diagnosis). Treated patients had a NMV/r claim within 0-4 days following index and were directly matched (1:1) with untreated patients on age, sex, index quarter, Charlson Comorbidity Index score, and pre-index hospitalization/emergency room visit. Per-patient-per-month (PPPM) indirect costs (estimated by multiplying median 2022 wage by absence days or 70% of disability days) were calculated over the variable post-index period and reported as monthly costs per 1,000 employees.
RESULTS: The matched absence, STD, and LTD cohorts included 1,909, 20,065, and 20,318 treated and untreated patients, respectively. Over the median 5 months of follow-up, per 1,000 individuals, treated employees had lower monthly costs attributed to: absence ($434,120 vs. $468,377; -$34,257 [95%CI:-$66,460;-$1,540]), STD ($84,153 vs. $108,440; -$24,288 [95%CI:-$33,680;-$14,900]), and LTD ($4,390 vs. $7,350; -$2,960 [95%CI:-$5,800;-$120]) compared to untreated employees. Indirect cost savings for treated compared to untreated employees were greater within subsets of individuals with baseline chronic lung disease (absence:-$176,746 [95%CI:-$371,360;$17,360]; STD:-$34,227 [95%CI:-$110,430;$41,990]; LTD:-$27,467 [95%CI:-$57,620;$2,680]) or overweight/obesity (absence:-$98,073 [95%CI:-$156,790;-$41,210]; STD:-$26,329 [95%CI:-$45,020;-$7,640]; LTD:-$4,666 [95%CI:-$11,260;$2,020]).
CONCLUSIONS: Lower indirect costs observed in treated cohorts, especially among employees with comorbid conditions, indicate that NMV/r treatment may provide a societal benefit in addition to previously demonstrated direct healthcare benefits.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE69
Topic
Economic Evaluation
Topic Subcategory
Work & Home Productivity - Indirect Costs
Disease
SDC: Infectious Disease (non-vaccine)