Cost-Effectiveness of Remdesivir for COVID-19 Treatment: What Are We Missing?


Since the beginning of the COVID-19 pandemic, at least 5.6 million people have died of COVID-19 globally as of January 2022. In the early stages of the pandemic, nonpharmaceutical interventions (eg, closure of business, social distancing) were the primary mode of controlling the spread of the novel coronavirus, severe acute respiratory syndrome coronavirus 2, thereby reducing COVID-19–associated hospitalizations and deaths. One study estimated the total cost of the COVID-19 pandemic in the United States to be at least $16 trillion. Therefore, interventions that reduce the spread or mortality of COVID-19 would have immense social value.
Several effective treatments and vaccines are now available that can potentially change—and have changed—the landscape of COVID-19. Remdesivir was the first treatment for COVID-19 that received emergency use authorization in the United States in May 2020 and conditional approval in Europe in July 2020. Remdesivir was immediately in high demand because of the high COVID-19 burden. Although the clinical evidence was still emerging, Gilead Sciences, the manufacturer of remdesivir, had to set a price of the treatment for a disease that had caused a global pandemic and affected every sector of human life. Priced at $520 per vial ($3120 for the 5-day treatment course) in the United States and £340 per vial (£2040 for the 5-day treatment course) in the United Kingdom, remdesivir has been at the center of a debate regarding how to assess its value for treating COVID-19.
Two studies published in the current issue of Value in Health attempted to evaluate the cost-effectiveness of remdesivir for COVID-19 treatment. Whittington et al conducted their analysis in the United States and Rafia et al in England and Wales. Interestingly, both studies reached a similar conclusion—remdesivir is cost-effective if it reduces mortality in patients with COVID-19 and not cost-effective otherwise. Whittington et al
estimated the incremental cost-effectiveness of ratio (ICER) of remdesivir equal to $298 200 per quality-adjusted life-year (QALY) without mortality benefit and $50 100 per QALY with mortality benefit. Rafia et al found the corresponding ICERs to be > £1 million per QALY without mortality benefit and £12 400 per QALY with mortality benefit.


Jagpreet Chhatwal Anirban Basu

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