Presentation (CTI)

OBJECTIVES: Nirmatrelvir/ritonavir (N/R) is an antiviral agent recommended for adults at increased risk for severe COVID-19, irrespective of vaccination status, and is reimbursed in Sweden according to label. Both the pivotal study EPIC-HR and real-world data affirm its effectiveness in preventing hospitalization and death. N/R is a cost-effective treatment for many patient cohorts, and a dominant treatment option for most elderly patients. This study assesses the potential of N/R to alleviate the burden on health care systems in terms of reducing hospitalizations due to COVID-19 by treating patients before being hospitalized.
METHODS: This study employed a previously published and validated closed-cohort, static, cost-effectiveness model to compare N/R against standard of care (SoC), which excludes antiviral agents, in an outpatient setting. Updated data on vaccination status (never vaccinated; vaccinated before October 1, 2024; vaccinated between October 1, 2024 and March 19, 2025) were used. The model differentiated hospitalization risks by vaccination status and comorbidity levels across the age cohorts 70-79 and 80+ for each Swedish region (n=21). Based on real-world evidence, the study quantified the reduction in inpatient days when treating 1,000 patients with N/R instead of SoC.
RESULTS: Treating a cohort of 1,000 Swedish patients aged 70/80 years with N/R saved an average of 347/538 inpatient days. When focusing treatment on non-recently vaccinated patients (>180 days post-vaccination), saved inpatient days increased to 621/972. In the region with the highest recent (<180 days) vaccination rate, treatment saved 290/485 inpatient days, while treatment in the region with the lowest rate saved 364/573 inpatient days.
CONCLUSIONS: This study suggests that cost-effective utilization of nirmatrelvir/ritonavir in patients at least 70 years old can substantially alleviate the burden of COVID-19 on health care systems in terms of freeing hospital beds for other prioritized patients.