- •The debate on how to assess the value of therapeutics for COVID-19 treatments continues as treatments (eg, remdesivir) gain regulatory approval and progress through clinical trials.
- •This article suggests the cost-effectiveness of remdesivir for hospitalized patients with COVID-19 and identifies key drivers of value to guide future pricing and reimbursement efforts.
- •With the current evidence available, remdesivir’s price is too high to align with its expected health gains. Results from this study provide a rationale for iterative health technology assessments in a pandemic.
- Roser M.
- Ritchie H.
- Ortiz-Ospina E.
- Hasell J.
- Ip G.
- Beasley D.
- Karlin-Smith S.
- Campbell J.D.
- Whittington M.D.
- Rind D.
- Pearson S.D.
|Model choice or assumption||Rationale|
|The perspective of our analysis focuses on costs to the healthcare payer.||The complexity of the societal impact of the COVID-19 pandemic challenges the ability to estimate the impact of a noncurative treatment on societal factors such as unemployment, taxes, and education. Further, it is unlikely that policy makers will find pricing that shifts societal economic benefits to a single life science company appropriate.|
|The price of remdesivir was $520 per vial and was in addition to the price of the COVID-19 hospitalization.||This price aligns with the price the manufacturer stated would be charged to private payers. The manufacturer announced a lower price for government-sponsored payers; nevertheless, because the government-sponsored price is only for those government payers who directly purchase remdesivir from the manufacturer, which represents a minority of government-sponsored payers in the United States, the private payer price was used in this analysis. Patients not receiving mechanical ventilation received 6 vials; patients receiving mechanical ventilation received 11 vials based on the FDA package insert.|
|Remdesivir is not associated with a survival benefit.||Neither individual trials nor a large meta-analysis suggested a significant improvement in survival associated with remdesivir. Extensive consideration of all the data and engagement with stakeholders informed this decision, and this assumption was tested in a scenario analysis.|
|The COVID-19 hospitalization would be reimbursed as a bundled payment that varied based on the level of respiratory support received.||This most closely aligns with a bundled payment approach where an episode of care is reimbursed as a single payment. In a scenario analysis, we modeled the reimbursement for the hospitalization based on a per diem payment structure.|
|No ongoing cost or disutility associated with COVID-19 was applied after hospital discharge.||We do not attempt to quantify long-term sequelae in the results for numerous reasons, including a lack of consensus on a standardized definition and duration of long COVID-19, mixed estimates of the percentage of patients who experience long COVID-19, no data on the influence of remdesivir on long COVID-19, no data to suggest long COVID-19 differs by time to recovery, and currently available data originating from small samples. Primarily, we do not quantify long COVID-19 in our analyses because it would not be a key driver of the findings for the cost-effectiveness of remdesivir.|
|Moderate to severe population||Remdesivir costs, $||Hospitalization costs, $||Other healthcare costs, $||Total QALYs|
|ICER ($/QALY), $||Value-based price, $|
|Remdesivir + SoC||3989||36 694||272 764||12.189||$298 200||2470-3080|
|SoC||0||38 853||272 764||12.182|
|Mild population||Remdesivir costs, $||Hospitalization costs, $||Other healthcare costs, $||Total QALYs|
|ICER ($/QALY), $||Value-based price, $|
|Remdesivir + SoC||2746||12 913||302 716||13.702||1 847 000||70-220|
|SoC||0||12 913||302 716||13.701|
Sensitivity and Scenario Analyses
|Moderate to severe population||Remdesivir costs, $||Hospitalization costs, $||Other healthcare costs, $||Total LYs||Total QALYs||ICER ($/QALY), $||Value-based price, $|
|Emerging therapy + SoC||3989||36 694||275 717||15.281||12.278||50 100||4000-13 500|
|SoC||0||8 853||272 764||15.164||12.182|
|Mild population||Remdesivir costs, $||Hospitalization costs, $||Other healthcare costs, $||Total LYs||Total QALYs||ICER ($/QALY), $||Value-based price, $|
|Emerging therapy + SoC||2746||12 913||303 942||17.043||13.739||103 400||700-4600|
|SoC||0||12 913||302 716||16.995||13.701|
- Dubois R.W.
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