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. 2021 Jan 29;8(3):ofab040.
doi: 10.1093/ofid/ofab040. eCollection 2021 Mar.

Cost-effectiveness of Remdesivir and Dexamethasone for COVID-19 Treatment in South Africa

Youngji Jo  1 , Lise Jamieson  2 , Ijeoma Edoka  3 , Lawrence Long  2   4 , Sheetal Silal  5   6 , Juliet R C Pulliam  7 , Harry Moultrie  8 , Ian Sanne  2 , Gesine Meyer-Rath  2   4 , Brooke E Nichols  2   4
Affiliations

Cost-effectiveness of Remdesivir and Dexamethasone for COVID-19 Treatment in South Africa

Youngji Jo et al. Open Forum Infect Dis. .

Abstract

Background: Dexamethasone and remdesivir have the potential to reduce coronavirus disease 2019 (COVID)-related mortality or recovery time, but their cost-effectiveness in countries with limited intensive care resources is unknown.

Methods: We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed the cost-effectiveness of (1) administration of dexamethasone to ventilated patients and remdesivir to nonventilated patients, (2) dexamethasone alone to both nonventilated and ventilated patients, (3) remdesivir to nonventilated patients only, and (4) dexamethasone to ventilated patients only, all relative to a scenario of standard care. We estimated costs from the health care system perspective in 2020 US dollars, deaths averted, and the incremental cost-effectiveness ratios of each scenario.

Results: Remdesivir for nonventilated patients and dexamethasone for ventilated patients was estimated to result in 408 (uncertainty range, 229-1891) deaths averted (assuming no efficacy [uncertainty range, 0%-70%] of remdesivir) compared with standard care and to save $15 million. This result was driven by the efficacy of dexamethasone and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone for nonventilated and ventilated patients requires an additional $159 000 and averts 689 [uncertainty range, 330-1118] deaths, resulting in $231 per death averted, relative to standard care.

Conclusions: The use of remdesivir for nonventilated patients and dexamethasone for ventilated patients is likely to be cost-saving compared with standard care by reducing ICU days. Further efforts to improve recovery time with remdesivir and dexamethasone in ICUs could save lives and costs in South Africa.

Keywords: COVID-19; SARS-CoV-2; cost-effectiveness; dexamethasone; hospital bed capacity; intensive care; mathematical model; remdesivir.

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Figures

Figure 1.
Figure 1.
One-way sensitivity analyses of incremental cost-effectiveness ratio assessing the use of remdesivir for nonventilated intensive care unit patients and dexamethasone for ventilated patients compared with standard care (assuming 0% efficacy of remdesivir in directly reducing mortality). Abbreviation: ICU, intensive care unit.
Figure 2.
Figure 2.
Three-way sensitivity analyses of incremental cost-effectiveness ratio assessing the use of remdesivir for nonventilated intensive care unit (ICU) patients and dexamethasone for ventilated patients compared with standard care. This heat map displays the incremental cost-effectiveness (red as an incremental cost per death averted; green as an incremental cost saving per death averted) of the scenario of remdesivir and dexamethasone compared with standard care (A) and the scenario of dexamethasone use in ventilated and nonventilated patients compared with standard care (B). Each panel corresponds to a relative epidemic condition (the extent of ICU capacity is breached across 6 months/9 provinces: full [ICUs always at capacity], base [ICUs at capacity as per modeled results], low [ICUs never at capacity]). In (A), each column represents a different length of reduced ICU stay by remdesivir and each row depicts a different remdesivir efficacy (0%, 30%, 70%). In (B), each column represents a different dexamethasone efficacy (18%, 35%, 49%), and each row depicts a different dexamethasone cost ($16, $31, $47).
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