OBJECTIVES: The objective of this analysis is to assess the cost-effectiveness (CE) of tocilizumab plus usual care versus usual care alone for the treatment of Coronavirus Disease 19 (COVID-19) in hospitalised patients on corticosteroids, requiring supplemental oxygen or mechanical ventilation and having a c-reative protein (CRP) level ≥75mg/L.

METHODS: The cost-effectiveness model (CE model) sources results from RECOVERY, a phase III, multi-center, randomized clinical trial sponsored by the University of Oxford. It models the acute phase of the COVID-19 infection through a decision tree and the rest of life through a Markov model. It uses this approach because treatment and its associated outcomes are realised over a short-term period while still allowing it to consider the long-term consequences of COVID-19 on healthcare costs and quality of life. At the start of the acute phase, all patients are hospitalised. As patients should be on oxygen support to be eligible for tocilizumab, patients start on either supplemental oxygen, non-invasive ventilation or mechanical ventilation. Patients can proceed to higher levels of oxygen support while they are in hospital and can leave the acute phase either alive or dead. In the second phase, the model assumes that all patients enter the Markov model without health issues. The perspective of the analysis is that of the Italian public payer.

RESULTS: The model estimates an incremental gain of 0.813 quality-adjusted life years (QALYs) and 0.919 life years (LY), at a cost saving of €-1,105. Overall, tocilizumab is dominant versus usual care (i.e. leads to higher QALYs and lower costs).

CONCLUSIONS: The cost-effectiveness model shows that the value of tocilizumab plus usual care is driven by preventing a percentage of patients from proceeding to higher levels of respiratory support in comparison to the support at baseline, and reduction in the probability of death while in hospital.