School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
Value Health. 2022 May;25(5):761-769. doi: 10.1016/j.jval.2021.12.015. Epub 2022 Feb 20.
COVID-19 is associated with significant morbidity and mortality. This study aims to synthesize evidence to assess the cost-effectiveness of remdesivir (RDV) for the treatment of hospitalized patients with COVID-19 in England and Wales.
A probabilistic cost-effectiveness analysis was conducted informed by 2 large trials and uses a partitioned survival approach to assess short- and long-term clinical consequences and costs associated with COVID-19 in a hypothetical cohort of hospitalized patients requiring supplemental oxygen at the start of treatment. Given that it is uncertain whether RDV reduces death, 2 analyses are presented, assuming RDV either reduces death or does not. Published sources were used for long-term clinical, quality of life, and cost parameters.
Under the assumption that RDV reduces death, the incremental cost-effectiveness ratio for RDV is estimated at £11 881 per quality-adjusted life-year gained compared with standard of care (SoC) (probabilistic incremental cost-effectiveness ratio £12 400). The probability for RDV to be cost-effective is 74% at a willingness-to-pay threshold of £20 000 per quality-adjusted life-year gained. RDV was no longer cost-effective when the hazard ratio for overall survival compared with SoC was >0·915.
Results from this study suggest that using RDV for the treatment of hospitalized patients with COVID-19 is likely to represent a cost-effective use of National Health Service resources at current willingness-to-pay threshold in England and Wales, only if it prevents death. Results needs to be interpreted caution as vaccination was introduced and the SoC and evidence available have also evolved considerably since the analysis is conducted.
COVID-19 与重大发病率和死亡率相关。本研究旨在综合证据评估瑞德西韦（RDV）治疗英国和威尔士住院 COVID-19 患者的成本效益。
根据两项大型试验，进行概率成本效益分析，采用分区生存方法评估开始治疗时需要补充氧气的住院患者假设队列中与 COVID-19 相关的短期和长期临床后果和成本。鉴于尚不确定 RDV 是否降低死亡率，因此进行了两种分析，假设 RDV 要么降低死亡率，要么不降低死亡率。长期临床、生活质量和成本参数使用已发表的资料。
假设 RDV 降低死亡率，与标准治疗（SoC）相比，RDV 每获得一个质量调整生命年的增量成本效益比估计为 11881 英镑（概率增量成本效益比为 12400 英镑）。在获得每质量调整生命年 20000 英镑的意愿支付阈值下，RDV 的成本效益概率为 74%。当与 SoC 相比的总生存风险比>0.915 时，RDV 不再具有成本效益。
本研究结果表明，在英国和威尔士当前的意愿支付阈值下，使用 RDV 治疗住院 COVID-19 患者可能代表对国民保健服务资源的有效利用，前提是它能预防死亡。由于疫苗接种的引入以及 SoC 和现有证据也发生了很大变化，因此需要谨慎解释结果。分析是在进行的。
