COST-EFFECTIVENESS OF ORAL NIRMATRELVIR-RITONAVIR IN PATIENTS AT HIGH RISK FOR PROGRESSION TO SEVERE COVID-19 IN THE UNITED STATES
Author(s)
Tendai Mugwagwa, MSc, PhD1, Adam Kasle, BA2, Ruth Mokgokong, MSc, PhD3, David Campbell, MS, PharmD4, Kristen Migliaccio-Walle, BS5, David Veenstra, PharmD, PhD6.
1Pfizer inc, Tadworth, United Kingdom, 2Curta, Washington, DC, USA, 3Pfizer, Tadworth, United Kingdom, 4Curta, South Kingstown, RI, USA, 5Curta, Hollis, NH, USA, 6Curta Inc., Seattle, WA, USA.
1Pfizer inc, Tadworth, United Kingdom, 2Curta, Washington, DC, USA, 3Pfizer, Tadworth, United Kingdom, 4Curta, South Kingstown, RI, USA, 5Curta, Hollis, NH, USA, 6Curta Inc., Seattle, WA, USA.
OBJECTIVES: Nirmatrelvir/ritonavir (NMV/r) is used to treat mild-to-moderate COVID-19 in adults at high-risk (age 50+ or with an underlying medical condition) for progression to severe disease. To assess the economic value of NMV/r treatment in 2026, we developed a cost-effectiveness model for NMV/r versus best supportive care from a US societal perspective.
METHODS: A cost-effectiveness model was developed using a short-term decision-tree (1 year) followed by a lifetime two-state Markov model (alive and dead). The short-term decision-tree captured costs and outcomes associated with the primary infection, healthcare utilization, and productivity losses; survivors of the short-term decision-tree were followed until death assuming US general population quality-adjusted life years (QALYs), adjusted in the short-term for survivors of mechanical ventilation. Baseline rate of hospitalization (3.43%) and NMV/r reduction in hospitalization (79.6%) were taken from an Omicron era US real-world study. Post-COVID conditions (PCC) were included in a scenario analysis based on a real-world study evaluating the impact of NMV/r on 13 post-COVID sequalae. All other clinical and cost inputs were informed by contemporary COVID-19 studies and publicly available US sources, including NMV/r treatment cost ($1,541). Costs and outcomes were discounted annually at 3%. Deterministic and probabilistic sensitivity analyses were conducted to test robustness of model results.
RESULTS: Treatment with NMV/r was found to decrease COVID-19 related hospitalizations (-0.027 per infection), increase QALYs (+0.035), decrease hospitalization costs (-$614) and increase total treatment cost (+$914). This resulted in an incremental cost-effectiveness ratio of $26,234/QALY; when considering impacts of PCC, the ICER was $5,556. Results were consistent across sensitivity and scenario analyses.
CONCLUSIONS: NMV/r is cost-effective versus best supportive care at a willingness-to-pay threshold of $150,000 per QALY for patients at high risk for severe COVID-19 from a US societal perspective. These findings support the clinical and economic value of NMV/r in the current COVID-19 landscape.
METHODS: A cost-effectiveness model was developed using a short-term decision-tree (1 year) followed by a lifetime two-state Markov model (alive and dead). The short-term decision-tree captured costs and outcomes associated with the primary infection, healthcare utilization, and productivity losses; survivors of the short-term decision-tree were followed until death assuming US general population quality-adjusted life years (QALYs), adjusted in the short-term for survivors of mechanical ventilation. Baseline rate of hospitalization (3.43%) and NMV/r reduction in hospitalization (79.6%) were taken from an Omicron era US real-world study. Post-COVID conditions (PCC) were included in a scenario analysis based on a real-world study evaluating the impact of NMV/r on 13 post-COVID sequalae. All other clinical and cost inputs were informed by contemporary COVID-19 studies and publicly available US sources, including NMV/r treatment cost ($1,541). Costs and outcomes were discounted annually at 3%. Deterministic and probabilistic sensitivity analyses were conducted to test robustness of model results.
RESULTS: Treatment with NMV/r was found to decrease COVID-19 related hospitalizations (-0.027 per infection), increase QALYs (+0.035), decrease hospitalization costs (-$614) and increase total treatment cost (+$914). This resulted in an incremental cost-effectiveness ratio of $26,234/QALY; when considering impacts of PCC, the ICER was $5,556. Results were consistent across sensitivity and scenario analyses.
CONCLUSIONS: NMV/r is cost-effective versus best supportive care at a willingness-to-pay threshold of $150,000 per QALY for patients at high risk for severe COVID-19 from a US societal perspective. These findings support the clinical and economic value of NMV/r in the current COVID-19 landscape.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE344
Topic
Economic Evaluation, Epidemiology & Public Health, Study Approaches
Disease
Infectious Disease (non-vaccine), Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)