Evidence for Access, Genentech, Inc, South San Francisco, CA, USA.
Health Economics, BresMed Health Solutions, Las Vegas, NV, USA.
Adv Ther. 2021 Apr;38(4):1811-1831. doi: 10.1007/s12325-021-01654-5. Epub 2021 Feb 27.
The COVID-19 pandemic is a global crisis impacting population health and the economy. We describe a cost-effectiveness framework for evaluating acute treatments for hospitalized patients with COVID-19, considering a broad spectrum of potential treatment profiles and perspectives within the US healthcare system to ensure incorporation of the most relevant clinical parameters, given evidence currently available.
A lifetime model, with a short-term acute care decision tree followed by a post-discharge three-state Markov cohort model, was developed to estimate the impact of a potential treatment relative to best supportive care (BSC) for patients hospitalized with COVID-19. The model included information on costs and resources across inpatient levels of care, use of mechanical ventilation, post-discharge morbidity from ventilation, and lifetime healthcare and societal costs. Published literature informed clinical and treatment inputs, healthcare resource use, unit costs, and utilities. The potential health impacts and cost-effectiveness outcomes were assessed from US health payer, societal, and fee-for-service (FFS) payment model perspectives.
Viewing results in aggregate, treatments that conferred at least a mortality benefit were likely to be cost-effective, as all deterministic and sensitivity analyses results fell far below willingness-to-pay thresholds using both a US health payer and FFS payment perspective, with and without societal costs included. In the base case, incremental cost-effectiveness ratios (ICER) ranged from $22,933 from a health payer perspective using bundled payments to $8028 from a societal perspective using a FFS payment model. Even with conservative assumptions on societal impact, inclusion of societal costs consistently produced ICERs 40-60% lower than ICERs for the payer perspective.
Effective COVID-19 treatments for hospitalized patients may not only reduce disease burden but also represent good value for the health system and society. Though data limitations remain, this cost-effectiveness framework expands beyond current models to include societal costs and post-discharge ventilation morbidity effects of potential COVID-19 treatments.
COVID-19 大流行是一场影响人口健康和经济的全球危机。我们描述了一种用于评估住院 COVID-19 患者急性治疗的成本效益框架，考虑了美国医疗保健系统内广泛的潜在治疗方案和观点，以确保纳入当前可用证据的最相关临床参数。
使用短期急性护理决策树和出院后三状态马尔可夫队列模型开发了一个生命周期模型，以估计与最佳支持治疗（BSC）相比，对 COVID-19 住院患者的潜在治疗方法的影响。该模型包括住院治疗水平、使用机械通气、通气后发病和终生医疗保健和社会成本的信息。已发表的文献提供了临床和治疗输入、医疗资源使用、单位成本和效用信息。从美国健康支付者、社会和按服务付费（FFS）支付模型的角度评估了潜在的健康影响和成本效益结果。
从总体上看，观察到具有至少降低死亡率的治疗效果的治疗方法可能具有成本效益，因为所有确定性和敏感性分析结果均远低于使用美国健康支付者和 FFS 支付模型从支付者和 FFS 支付角度来看，包括社会成本在内，使用捆绑支付的视角下，增量成本效益比（ICER）范围从支付者视角下的 22933 美元到 FFS 支付模型下的社会视角下的 8028 美元不等。即使对社会影响做出保守假设，包括社会成本始终会使支付者视角下的 ICER 降低 40-60%。
有效的 COVID-19 住院患者治疗方法不仅可以减轻疾病负担，而且对卫生系统和社会具有良好的价值。尽管数据仍存在局限性，但该成本效益框架超越了当前模型，包括社会成本和潜在 COVID-19 治疗的出院后通气发病影响。
