WHAT IS THE CADTH REIMBURSEMENT RECOMMENDATION FOR VEKLURY?: CADTH recommends that Veklury be reimbursed by public drug plans for the treatment of COVID-19 in adults who are not hospitalized and have positive results of direct severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral testing and who are at high risk for progression to severe COVID-19, including hospitalization and death, if certain conditions are met. WHICH PATIENTS ARE ELIGIBLE FOR COVERAGE? Veklury should only be covered to treat patients who meet the criteria used by each of the public drug programs for reimbursement of Paxlovid for the treatment of COVID-19 in adults. Treatment should be initiated as soon as possible and within 7 days of symptom onset. WHAT ARE THE CONDITIONS FOR REIMBURSEMENT? Veklury should only be reimbursed if treatment does not exceed 3 days, is not used in combination with any other antiviral medication for COVID-19 (including Paxlovid), and the cost is reduced. WHY DID CADTH MAKE THIS RECOMMENDATION? Evidence from 1 clinical trial demonstrated that patients with COVID-19 who were considered to be at high risk for progression to severe disease but were not hospitalized could benefit from Veklury for preventing hospitalization. There is uncertainty about whether these findings reflect the actual benefits of Veklury because the trial took place before omicron (B.1.1.529) was the main circulating variant, the patients in the trial were unvaccinated, and they were enrolled based on a definition of high risk that no longer meets the current definition used by clinicians today. Veklury may meet patients’ unmet needs by reducing the risk of severe disease leading to hospitalization in those with moderate to severe immune suppression who are, therefore, at risk of complications from progressing to severe COVID-19. However, it is uncertain what impact Veklury has on mortality based on the trial results. Veklury may also address patients’ need for a COVID-19 treatment that does not present contraindications with their current medication. Based on CADTH’s assessment of the health economic evidence, Veklury does not represent good value to the health care system at the public list price. A price reduction is therefore required. Based on public list prices, Veklury is estimated to cost the public drug plans approximately $3.4 million over the next 3 years; however, this depends on the number of COVID-19 cases and the uptake of Veklury.
WHAT IS COVID-19? COVID-19 is an illness caused by SARS-CoV-2, the rapid global spread of which led to a pandemic in March 2020. Although the majority of people who have COVID-19 experience mild symptoms, COVID-19 can lead to serious medical complications associated with high morbidity and mortality. The risk factors that affect progression to severe disease have evolved over time. Population immunity has increased, and the number and characteristics of patients hospitalized because of COVID-19 have changed. According to a November 2023 WHO living guideline, patients at high risk of serious complications, including those with a compromised immune system, have an estimated 6% hospitalization rate. UNMET NEEDS IN COVID-19: The patient group expressed a need for access to treatments that are effective at reducing the risk of severe disease and death caused by the currently circulating COVID-19 variants. Patients also expressed the need for a treatment that does not have contraindications with their current medications. HOW MUCH DOES VEKLURY COST? Treatment with Veklury is expected to cost approximately $2,642 per 3-day course.
