An evaluation of vilobelimab (anti-C5a) as a cost-effective option to treat severely ill mechanically ventilated patients with COVID-19

Abstract

Purpose: COVID-19 patients in intensive care units (ICUs) requiring invasive mechanical ventilation (IMV) have few available treatment options. PANAMO, a multicenter, double-blind, randomized, placebo-controlled phase 3 study of vilobelimab, which blocks the inflammatory process caused by complement component 5a, demonstrated a significant mortality benefit at 28 and 60 days in these patients. A cost-effectiveness analysis was conducted to assess the incremental cost per quality-adjusted life-year (QALY).

Methods: A Markov model was used to estimate QALYs and the incremental cost-effectiveness ratio (ICER) of vilobelimab plus standard of care (SOC) versus SOC alone. The model simulated progression from severe COVID-19 to survival or death over a lifetime horizon. Outcomes data (COVID-19 all-cause mortality and renal replacement therapy) were incorporated from the PANAMO trial. COVID-19 mortality estimates were based on Centers for Disease Control and Prevention age-specific survival data. Utility values and hospital costs came from the literature. Vilobelimab cost was obtained from RED BOOK Online.

Results: For COVID-19 ICU patients, total costs of care were $103,414 (SOC) and $132,247 (SOC plus vilobelimab), respectively, resulting in an incremental cost of $28,833. SOC provided 6.70 QALYs versus 7.99 QALYs for vilobelimab, an additional 1.29 QALYs. The ICER for vilobelimab plus SOC versus SOC alone was $22,287/QALY. Probabilistic sensitivity analysis demonstrated the robustness of the cost-effectiveness result as vilobelimab plus SOC was favored at a willingness-to-pay threshold of $50,000 in over 81% of iterations.

Conclusion: Vilobelimab provides a cost-effective option to treat ICU patients with severe COVID-19 receiving IMV compared to SOC, at well below the commonly accepted $50,000 US willingness-to-pay threshold.

Keywords: COVID-19; QALY; cost-effectiveness analysis; quality adjusted life years; treatment effectiveness; vilobelimab.

Figure 1.

Cost-effectiveness model structure used for the analysis, showing short-term decision tree (hospitalization) and long-term Markov model (posthospitalization).

Figure 2.

Cost-effectiveness acceptability curve of vilobelimab versus standard of care (SOC) at a willingness-to-pay threshold of $50,000.

Figure 3.

Incremental cost-effectiveness ratio (ICER) scatterplot of vilobelimab versus standard of care (SOC), with a willingness-to-pay threshold (WTP) of $50,000.

Figure 4.

Tornado diagram for vilobelimab versus standard of care (SOC), showing the parameters with the greatest impact on the incremental cost-effectiveness ratio were survival rate and age.