Analisi di costo-efficacia di nirmatrelvir/ritonavir in pazienti adulti ad alto rischio di progressione a COVID-19 severo

Abstract

Objective:: This study aimed to estimate the cost-effectiveness of nirmatrelvir/ritonavir (NMV/r) versus the standard of care (SoC) for patients with mild-to-moderate coronavirus disease 2019 (COVID-19) at high risk for progression to severe illness from the perspective of the Italian National Health Service.

Methods:: A cost-effectiveness model was developed using a closed cohort of 1,000 infected patients. It employed a short-term decision tree (1 year) followed by a lifetime 2-state Markov model (alive and dead). The short-term decision tree captured costs and outcomes associated with the primary infection and healthcare utilization; survivors of the short-term decision tree were followed until death to calculate Italian quality-adjusted life years (QALYs), adjusted in the short-term for survivors to mechanical ventilation. Baseline hospitalization rate and NMV/r effectiveness were sourced from the Istituto Superiore di Sanità (ISS) and the randomized clinical trial Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients (EPIC-HR), respectively. Other inputs were given by previous COVID-19 studies and publicly available sources. Sensitivity analyses were conducted for all model inputs to test the robustness of the results of the model.

Results:: NMV/r presented an advantageous cost-effectiveness ratio of 2,237 €/QALY, compared to the SoC, in the long-term horizon (30 years). Results were most sensitive to baseline risk of hospitalization and NMV/r treatment effectiveness parameters. The probabilistic analysis indicated that NMV/r has a 100% probability of being cost-effective at a 33,004 € willingness-to-pay threshold.

Conclusions:: From the Italian National Health Service perspective, NMV/r is cost-effective compared to the standard of care for patients at high risk for severe COVID-19.

FIGURA 1 -

Struttura del modello. *Decesso riconducibile alla mortalità della popolazione generale. Abbreviazioni: VM: ventilazione meccanica.

FIGURA 2 -

Risultati dell’analisi di sensibilità deterministica - diagramma tornado - NMV/r versus SoC (long-term module). Abbreviazioni: HR: hazard ratio; ICER: incremental cost effectiveness ratio; UTI: unità di terapia intensiva; VM: ventilazione meccanica.

FIGURA 3 -

Analisi di sensibilità probabilistica - diagramma scatter plot NMV/r versus SoC (long-term module). Abbreviazioni: QALY: quality-adjusted life year; WTP: willingness-to-pay threshold.

FIGURA 4 -

Analisi di sensibilità probabilistica - curva di accettabilità NMV/r versus SoC (long-term module). Abbreviazioni: WTP: willingness-to-pay threshold.