Nilsson Fredrik, Aldvén Martina, Gerdesköld Rappe Christian, Mugwagwa Tendai
Pfizer AB, Access and Value, Stockholm, Sweden.
Pfizer AB, Medical Affairs, Stockholm, Sweden.
J Med Econ. 2025 Dec;28(1):186-195. doi: 10.1080/13696998.2024.2444836. Epub 2025 Jan 17.
Nirmatrelvir/ritonavir (NMV/r) is an orally administered antiviral indicated for the outpatient treatment of adult patients with mild-to-moderate COVID-19 at high risk for disease progression to severe illness. We estimated the cost-effectiveness of NMV/r versus best supportive care for 54 patient cohorts, specified according to age, vaccination status and comorbidity burden.
A previously published and validated cost-effectiveness model was utilized and adapted to the Swedish setting. The model used a short-term decision-tree (1 year) followed by a lifetime 2-state Markov model. The short-term decision-tree captured costs and outcomes associated with the primary infection. Post-acute COVID-19 syndrome was only considered in terms of quality-of-life decrements for one year. Baseline hospitalization and mortality risks were taken from a Swedish, nationwide, uniquely granular, Omicron-era, real-world study. NMV/r effectiveness were taken from an Omicron-era US real-world study. Remaining inputs were informed by previous COVID-19 studies and publicly available Swedish sources.
The incremental cost-effectiveness ratios (ICERs) showed a large variation ranging from almost nine million SEK for some of the youngest cohorts to being dominant (i.e. cost-saving with higher gains in quality-of-life vs standard of care) for twelve elderly cohorts. In general, higher age in combination with non-recent (>180 days) or no vaccination led to lower ICERs. Specifically, NMV/r was cost-effective for all but one patient cohorts at least 70 years old, and for most patient cohorts 60-69 years old.
As the COVID-19 landscape changes, symptom burden and baseline risks constantly change. Thus, the cost-effectiveness of NMV/r will change with time. However, the future risks could be related to the risks in the current study, and thus remain useful for decision makers.
This study shows that NMV/r is a cost-effective or even cost-saving treatment option for many patient cohorts, including most elderly and not-recently vaccinated patients with at least some comorbidity burden.
奈玛特韦/利托那韦（NMV/r）是一种口服抗病毒药物，适用于对疾病进展为重症风险较高的轻至中度新冠肺炎成年患者进行门诊治疗。我们评估了NMV/r与最佳支持治疗相比，针对54个根据年龄、疫苗接种状况和合并症负担划分的患者队列的成本效益。
采用并调整了一个先前发表并经验证的成本效益模型，使其适用于瑞典的情况。该模型使用了一个短期决策树（1年），随后是一个终身两状态马尔可夫模型。短期决策树捕捉与初次感染相关的成本和结果。急性新冠肺炎综合征仅在生活质量下降一年的情况下予以考虑。基线住院和死亡风险取自瑞典一项全国性、粒度独特的奥密克戎时代真实世界研究。NMV/r的有效性取自奥密克戎时代美国的一项真实世界研究。其余输入数据参考了先前的新冠肺炎研究和瑞典公开可用的资料来源。
增量成本效益比（ICER）显示出很大差异，从一些最年轻队列的近900万瑞典克朗到12个老年队列的占优（即与标准治疗相比，成本节约且生活质量有更高提升）不等。一般来说，年龄较大且未近期（>180天）接种或未接种疫苗会导致较低的ICER。具体而言，NMV/r对除一个70岁及以上患者队列外的所有队列以及大多数60 - 69岁患者队列具有成本效益。
随着新冠肺炎情况的变化，症状负担和基线风险不断改变。因此，NMV/r的成本效益会随时间变化。然而，未来风险可能与当前研究中的风险相关，因此对决策者仍有帮助。
本研究表明，对于许多患者队列，包括大多数老年且近期未接种疫苗且至少有一定合并症负担的患者，NMV/r是一种具有成本效益甚至节约成本的治疗选择。
