1ISG-007 Cost analysis of remdesivir and nirmatrelvir/ritonavir for the early treatment of COVID19 vulnerable patients

<h3>Background and Importance</h3> Despite the end of the global health emergency, a vulnerable portion of the population remains at high-risk of developing severe forms of COVID-19. To address this, two antiviral drugs are used for early treatment: remdesivir (RDV), administered via intravenous infusion for 3-day outpatient, and nirmatrelvir/ritonavir (NRM/RTV), administered orally over 5 days. <h3>Aim and Objectives</h3> This study aims to conduct a cost analysis between RDV and NRM/RTV in the early treatment of severe COVID-19. <h3>Material and Methods</h3> A network meta-analysis was performed, based on the latest systematic review comparing RDV and NRM/RTV,¹ to estimate the relative risk (RR) of hospitalisation and severe adverse events. Assuming 100,000 eligible patients, two cost scenarios were estimated: all patients treated with RDV versus all treated with NRM/RTV. Costs include the ex-factory price of the drugs, hospitalisation, management of adverse events and outpatient settings for RDV, estimated using a ‘bottom-up’ micro-costing approach. Event incidence data from the approval RCT for RDV were used. <h3>Results</h3> The network meta-analysis reveals only indirect comparisons between RDV and NRM/RTV. The RR of hospitalisation for NRM/RTV compared to RDV is 2,80 (95% CI: 0,33–24,07), while for severe adverse events it is 0,92 (95% CI: 0,31–2,74). The SUCRA rank for hospitalisation is 0,91 for RDV and 0,58 for NRM/RTV; for adverse events it is 0,72 for RDV and 0,78 for NRM/RTV. The ex-factory cost is €1.800,00 for RDV and €1.336,29 for NRM/RTV. Hospitalisation costs €8.081,29, adverse event management costs €3.725,00, and the outpatient setting for RDV costs €137,58. The total estimated cost in the RDV scenario is €218.891.438,10 and in the NRM/RTV scenario €180.267.256,68. <h3>Conclusion and Relevance</h3> The analysis indicates no significant difference between therapies in preventing hospitalisations, but the SUCRA rank shows a higher efficacy and lower safety of RDV compared to NRM/RTV. In the RDV scenario, the total cost would be €197.758.000,00 for treatment, €14.465.688,10 for hospitalisations, and €6.667.750,00 for adverse events. In the NRM/RTV scenario, the total cost would be €133.629.000,00 for treatment, €40.503.926,68 for hospitalisations, and €6.134.330,00 for adverse events, resulting in savings of €38.624.181,42. <h3>References and/or Acknowledgements</h3> Zur, <i>et al</i>. - Efficacy and safety of antiviral treatments for symptomatic COVID-19 outpatients: Systematic review and network meta-analysis 2024. <h3>Conflict of Interest</h3> No conflict of interest