Translational Success and Pharmacoeconomic Lessons of Pandemic-Driven Drug Repurposing.

The COVID-19 pandemic spurred an unprecedented wave of drug repurposing as scientists and clinicians raced to find immediate treatment options for a novel disease. This narrative review examines how those crisis-driven repurposing efforts fared. It highlights key successes and failures in translating research into practice and assessing their pharmacoeconomic implications in high-income health systems. It also distills lessons to guide future pandemic preparedness and improve equitable global access to effective treatments. We performed a broad literature search across major databases (2020-2025) to identify studies and reports on repurposed COVID-19 therapies and health economic outcomes. While repurposing accelerated the delivery of treatments, results were mixed: a handful of existing drugs, such as the widely available steroid dexamethasone, that reduced mortality, emerged as life-saving interventions, but many other initially promising drugs ultimately showed limited or no efficacy. Agile translational research frameworks like large adaptive trials proved critical, separating truly effective therapies from many speculative candidates. From a pharmacoeconomic perspective, repurposed therapies yielded cost-effective breakthroughs and costly disappointments. High-income countries invested substantial resources in repurposed drugs. In some cases, this approach provided rapid access to evidence-based care but also led to significant spending on unproven interventions, underscoring the importance of timely evidence generation and prudent resource allocation. Disparities in access to effective therapies between wealthy and low-resource settings highlight a persistent global equity challenge. The collective experience of pandemic drug repurposing provides a pragmatic blueprint for balancing urgency with scientific rigor, economic prudence, and equity. This will ultimately guide how we might better pivot from crisis to cure in future global health emergencies.