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奈玛特韦/利托那韦用于高危人群新冠治疗的成本效益分析:一项建模研究

Cost-effectiveness Analysis of Nirmatrelvir/Ritonavir for COVID-19 Among Individuals at High Risk: A Modeling Study.

作者信息

Birnie Emma, Vergouwe Magda, Appelman Brent, Biemond Jason J, Heijmans Jarom, Nichols Brooke E, Wiersinga W Joost, Popping Stephanie

机构信息

Center for Infection and Molecular Medicine, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.

Amsterdam Institute for Immunology and Infectious Diseases, Infectious Diseases, Amsterdam, the Netherlands.

出版信息

Open Forum Infect Dis. 2025 Mar 26;12(4):ofaf187. doi: 10.1093/ofid/ofaf187. eCollection 2025 Apr.

Abstract

BACKGROUND

To prevent severe disease, nirmatrelvir/ritonavir (nirmatrelvir/r) is administered to individuals infected with SARS-CoV-2 who are at high risk, and it is currently priced at approximately $1375 in the Netherlands. We aim to evaluate the health outcomes and cost-effectiveness of nirmatrelvir/r among patients with high risk of severe disease.

METHODS

We used a decision-analytic model parameterized with clinical and health care utilization data from individuals at high risk who were infected with SARS-CoV-2 between September 2021 and November 2023. We assumed baseline event rates of 1% for hospitalization and 0.05% for intensive care unit admission. Nirmatrelvir/r-related factors were varied. Costs were collected from a third-party payer's perspective, and the cost-effectiveness threshold was <$88 000 per quality-adjusted life-year gained. Sensitivity analyses were performed to account for uncertainties.

RESULTS

This study included 949 individuals at high risk who were infected with SARS-CoV-2. The sample had a median age of 65 years (IQR, 53-75), and 416 (44%) participants were female. Comorbidities included obesity (25%), hematologic malignancy (21%), solid organ/stem cell transplantation (17%), and immunosuppressive medication use (47%). With an assumed low effectiveness, nirmatrelvir/r could reduce hospitalizations and deaths (relative risk reduction, 21% and 44%, respectively). With high effectiveness, relative risk reductions of 89% and 90% were calculated for hospitalizations and deaths. Higher baseline rates for intensive care unit and hospital admission positively influenced cost-effectiveness thresholds. Nirmatrelvir/r is cost-effectively priced at <$512 with low effectiveness and <$1071 with high effectiveness.

CONCLUSIONS

With current low baseline event rates for hospitalization, nirmatrelvir/r has the potential, not only to reduce hospitalizations and deaths in individuals with COVID-19 who are at high risk, but to do so cost-effectively with a drug price reduction of 22% to 63%. These findings are relevant for policy makers and physicians and emphasize the importance of reevaluating current drug pricing.

CLINICAL TRIALS REGISTRATION

NCT05195060 (ClinicalTrials.gov).

摘要

背景

为预防重症疾病,将奈玛特韦/利托那韦(nirmatrelvir/r)用于感染严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的高危个体,目前在荷兰其定价约为1375美元。我们旨在评估奈玛特韦/利托那韦在重症疾病高危患者中的健康结局和成本效益。

方法

我们使用了一个决策分析模型,该模型采用了2021年9月至2023年11月期间感染SARS-CoV-2的高危个体的临床和医疗保健利用数据进行参数化。我们假设住院的基线事件发生率为1%,重症监护病房入院的基线事件发生率为0.05%。对与奈玛特韦/利托那韦相关的因素进行了变化分析。从第三方支付方的角度收集成本,成本效益阈值设定为每获得一个质量调整生命年<$88000。进行敏感性分析以考虑不确定性。

结果

本研究纳入了949例感染SARS-CoV-2的高危个体。样本的中位年龄为65岁(四分位间距,53 - 75岁),416例(44%)参与者为女性。合并症包括肥胖(25%)、血液系统恶性肿瘤(21%)、实体器官/干细胞移植(17%)以及使用免疫抑制药物(47%)。假设疗效较低时,奈玛特韦/利托那韦可减少住院和死亡(相对风险降低分别为21%和44%)。假设疗效较高时,计算得出住院和死亡的相对风险降低分别为89%和90%。重症监护病房和住院的较高基线发生率对成本效益阈值有正向影响。奈玛特韦/利托那韦疗效较低时,成本效益良好的定价<$512,疗效较高时<$1071。

结论

鉴于目前住院的基线事件发生率较低,奈玛特韦/利托那韦不仅有可能降低COVID-19高危个体的住院率和死亡率,而且通过降低22%至63%的药品价格可实现成本效益。这些发现对政策制定者和医生具有参考价值,并强调了重新评估当前药品定价的重要性。

临床试验注册

NCT05195060(ClinicalTrials.gov)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/91ad/12006789/8b9fb7fb1a6c/ofaf187f1.jpg

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