Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, 6th Floor, Teaching Research and Wellness Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
Sci Rep. 2021 Sep 7;11(1):17787. doi: 10.1038/s41598-021-97259-7.
Despite COVID-19's significant morbidity and mortality, considering cost-effectiveness of pharmacologic treatment strategies for hospitalized patients remains critical to support healthcare resource decisions within budgetary constraints. As such, we calculated the cost-effectiveness of using remdesivir and dexamethasone for moderate to severe COVID-19 respiratory infections using the United States health care system as a representative model. A decision analytic model modelled a base case scenario of a 60-year-old patient admitted to hospital with COVID-19. Patients requiring oxygen were considered moderate severity, and patients with severe COVID-19 required intubation with intensive care. Strategies modelled included giving remdesivir to all patients, remdesivir in only moderate and only severe infections, dexamethasone to all patients, dexamethasone in severe infections, remdesivir in moderate/dexamethasone in severe infections, and best supportive care. Data for the model came from the published literature. The time horizon was 1 year; no discounting was performed due to the short duration. The perspective was of the payer in the United States health care system. Supportive care for moderate/severe COVID-19 cost $11,112.98 with 0.7155 quality adjusted life-year (QALY) obtained. Using dexamethasone for all patients was the most-cost effective with an incremental cost-effectiveness ratio of $980.84/QALY; all remdesivir strategies were more costly and less effective. Probabilistic sensitivity analyses showed dexamethasone for all patients was most cost-effective in 98.3% of scenarios. Dexamethasone for moderate-severe COVID-19 infections was the most cost-effective strategy and would have minimal budget impact. Based on current data, remdesivir is unlikely to be a cost-effective treatment for COVID-19.
尽管 COVID-19 具有显著的发病率和死亡率，但考虑到住院患者药物治疗策略的成本效益仍然至关重要，这有助于在预算限制内支持医疗保健资源决策。因此，我们使用美国医疗保健系统作为代表性模型，计算了使用瑞德西韦和地塞米松治疗中度至重度 COVID-19 呼吸道感染的成本效益。决策分析模型模拟了一名 60 岁患者因 COVID-19 住院的基本情况。需要吸氧的患者被认为是中度严重程度，而患有严重 COVID-19 的患者需要插管并接受重症监护。模型中模拟的策略包括给所有患者使用瑞德西韦、仅给中度和重度感染的患者使用瑞德西韦、给所有患者使用地塞米松、仅给重度感染的患者使用地塞米松、给中度感染的患者使用瑞德西韦/给重度感染的患者使用地塞米松、以及最佳支持性护理。模型数据来自已发表的文献。时间范围为 1 年；由于持续时间较短，因此未进行贴现。视角是美国医疗保健系统的付款人。中度/重度 COVID-19 的支持性护理费用为 11,112.98 美元，获得 0.7155 个质量调整生命年 (QALY)。所有患者使用地塞米松是最具成本效益的，增量成本效益比为 980.84 美元/QALY；所有瑞德西韦策略的成本更高，效果更差。概率敏感性分析表明，所有患者使用地塞米松在 98.3%的情况下是最具成本效益的。地塞米松治疗中度至重度 COVID-19 感染是最具成本效益的策略，对预算的影响最小。根据现有数据，瑞德西韦不太可能成为 COVID-19 的一种有效治疗方法。
