OBJECTIVES: Nirmatrelvir/ritonavir (NMV/r) is indicated for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who are at high risk for progression to severe COVID-19. NMV/r has also been authorized for emergency use by FDA for the treatment of mild-to-moderate COVID-19 in pediatric patients (12 years of age and older weighing at least 40 kg) who are at high risk for progression to severe COVID-19.

METHODS: A budget impact model was developed to assess the impact of NMV/r on healthcare costs in a hypothetical 1-million-member health plan over a 1-year period in the US. Population, clinical, and cost inputs were derived from published literature, focusing on the recent COVID-19 era of vaccinated patients and predominance of the Omicron variant. In the base-case it was assumed the only effect of NMV/r was a reduction in incidence (not severity) of hospitalization/death; its potential effect on post-COVID conditions (PCC) was assessed in a scenario analysis. Outcomes included the number of hospitalizations, total cost, per-member per-month (PMPM) costs, and annual cost per treated patient (PPPY). Sensitivity and scenario analyses were conducted to assess uncertainty around model inputs.

RESULTS: An estimated 37,499 patients were eligible for treatment with NMV/r over one year. NMV/r use was estimated to reduce the number of hospitalizations by 819 with a budget impact of $3,460,437, $0.29 PMPM and $92 PPPY. NMV/r was cost savings when including PCCs with a budget impact of -$1,912,380, -$0.16 PMPM and -$92 PPPY. Sensitivity analyses indicated results were most sensitive to the price of NMV/r, risk of hospitalization under supportive care, and risk of hospitalization with NMV/r treatment.

CONCLUSIONS: Treatment with NMV/r in the current COVID-19 era is estimated to result in substantial cost offsets due to reductions in hospitalization and modest budget impact to potential overall cost savings for US health plans.