OBJECTIVES: COVID-19 has imposed a significant burden on healthcare systems with devastating and broad medical, economic and social consequences. The objective of this cost effectiveness analysis is to assess the health and economic impact, associated with the introduction of nirmatrelvir/ritonavir as an antiviral treatment for SARS-CoV-2 for adult patients in Greece who do not require supplemental oxygen and who are at increased risk of developing severe disease.

METHODS: A Markov model was developed using data from EPIC-HR trial and published literature and evaluates a closed cohort of 1,000 infected individuals who receive antiviral treatment. The model target population are adult patients withSARS-CoV-2 infections at risk for developing severe disease, aligned with the population of the EPIC-HR trial. COVID-related costs (treatment costs and costs related to healthcare resource utilisation for infected individuals) were collected from official and publicly available sources. Analysis was considered from a Greek payer perspective. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results.

RESULTS: The one-year time horizon analysis reveals that treatment with nirmatrelvir/ritonavir is a cost saving strategy with a cost difference of -47.60€ and 0.002 incremental QALY per capita and indicates that nirmatrelvir/ritonavir is dominant over best supportive care with a net monetary benefit of 116.98€. Lifetime analysis across 1,000 infected individuals results to a cost difference of -47,602€ and 18 QALYs. Sensitivity analyses confirmed the robustness of the model.

CONCLUSIONS: Nirmatrelvir/ritonavir is considered to be a dominant (more effective, less costly) strategy over best supportive care for treating SARS-CoV-2 in Greece and leads to cost-savings for the public payer. The results of this analysis could be used to support the recommendations for the treatment algorithm of patients with SARS-COV-2.