Cost-Effectiveness Analysis of Oseltamivir, Favipiravir, and Remdesivir in the Treatment of COVID-19 Patients in Indonesia

Backgroud: The selection of antiviral therapy for COVID-19 should consider both clinical efficacy and economic feasibility. Oseltamivir, Favipiravir, and Remdesivir are commonly administered antivirals with varying cost-effectiveness profiles. Aims: This study evaluates the cost-effectiveness of these three antiviral agents in treating COVID-19, based on improvements in Cycle Threshold (CT) values and oxygen saturation (SpO₂) levels. Materials and Methods: A retrospective, cross-sectional study was conducted at Bahteramas General Hospital, Southeast Sulawesi, Indonesia. Of 2,108 COVID-19 patients, 337 met the inclusion criteria, with 88 patients having complete CT value data pre- and post-antiviral therapy. Cost-effectiveness was assessed by comparing total treatment costs with clinical outcomes, including length of hospital stay, CT value improvement, and SpO₂ recovery. Incremental Cost-Effectiveness Ratios (ICERs) were calculated for Favipiravir and Remdesivir relative to Oseltamivir. A one-way deterministic sensitivity analysis was performed to assess the impact of cost variations on cost-effectiveness outcomes. Results: The findings revealed that Favipiravir was associated with the shortest hospital stay, particularly in isolation rooms, compared to Remdesivir and Oseltamivir. Favipiravir also demonstrated the highest clinical effectiveness in improving patient outcomes (80%), followed by Oseltamivir (76.9%) and Remdesivir (66.7%). The highest treatment cost was associated with Remdesivir (US$3,699.64), followed by Oseltamivir (US$3,163.72), and Favipiravir (US$3,149.84). Cost-effectiveness analysis indicated that Favipiravir had the most favorable cost-effectiveness profile, with an ICER of US$3,870 per patient, compared to Remdesivir’s ICER of US$6,986. Sensitivity analysis identified treatment effectiveness as the most influential factor in reducing ICER values. Conclusion: This study underscores Favipiravir as the most cost-effective option for COVID-19 management, supporting its integration into standard treatment protocols grounded in clinical and economic evidence.