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Carlson J, Foos V, Kasle A, Mugwagwa T, Draica F, Lee Wiemken T, Nguyen JL, Cha-Silva A, Migliaccio-Walle K, Dzingina M. Cost-Effectiveness of Oral Nirmatrelvir/Ritonavir in Patients at High Risk for Progression to Severe COVID-19 in the United States. Value Health 2024; 27:164-172. [PMID: 38043712 DOI: 10.1016/j.jval.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/27/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Nirmatrelvir/ritonavir (NMV/r) is an orally administered antiviral indicated for the outpatient treatment of patients with mild-to-moderate COVID-19 at high risk for disease progression to severe illness. We estimated the cost-effectiveness of NMV/r versus best supportive care for patients with mild-to-moderate COVID-19 at high risk for progression to severe illness from a US health sector perspective. METHODS A cost-effectiveness model was developed using 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 assuming US quality-adjusted life years (QALYs), adjusted in the short-term for survivors of mechanical ventilation. Baseline rate of hospitalization and NMV/r effectiveness were taken from an Omicron-era US real-world study. Remaining inputs were informed by previous COVID-19 studies and publicly available US sources. Sensitivity analyses were conducted for all model inputs to test the robustness of model results. RESULTS NMV/r was found to decrease COVID-19 related hospitalizations (-0.027 per infected case) increase QALYs (+0.030), decrease hospitalization costs (-$1110), and increase total treatment cost (+$271), resulting in an incremental cost-effectiveness ratio of $8931/QALY. Results were most sensitive to baseline risk of hospitalization and NMV/r treatment effectiveness parameters. The probabilistic analysis indicated that NMV/r has a >99% probability of being cost-effective at a $100 000 willingness-to-pay threshold. CONCLUSIONS NMV/r is cost-effective vs best supportive care for patients at high risk for severe COVID-19 from a US health sector perspective.
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Affiliation(s)
- Josh Carlson
- Curta, Inc, Seattle, Washington, USA; The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
| | - Volker Foos
- Health Economics and Outcomes Research, Ltd, Cardiff, Wales, UK
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Bajwah S, Colquitt J, Loveman E, Bausewein C, Almond H, Oluyase A, Dzingina M, Maddocks M, Higginson IJ, Wells A. Pharmacological and nonpharmacological interventions to improve symptom control, functional exercise capacity and quality of life in interstitial lung disease: an evidence synthesis. ERJ Open Res 2021; 7:00107-2020. [PMID: 33532482 PMCID: PMC7836673 DOI: 10.1183/23120541.00107-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/13/2020] [Indexed: 11/09/2022] Open
Abstract
We assessed efficacy and effectiveness of pharmacological and nonpharmacological interventions in improving symptom control, functional exercise capacity and quality of life (QoL) in people living with fibrotic interstitial lung disease (ILD). We summarised evidence from three previous reviews (to June 2014) and conducted an updated search of nine databases and grey literature (2011-2019) (registration: CRD42017065933) for prospective studies of interventions aimed to alleviate symptoms, improve QoL or functional exercise capacity in fibrotic ILD. Data were synthesised through narrative synthesis or meta-analysed as appropriate. Forty-seven studies with 2527 participants were included. From 22 pharmacological studies of 11 different interventions (n=1683), the most tested interventions were bosentan and sildenafil. From 25 nonpharmacological studies, the most tested intervention was for pulmonary rehabilitation/exercise training (PR) (22 studies, n=748). There was an improvement in 6-min walk distance immediately following PR (six studies; n=200, mean difference (MD) (95% CI) 39.9 m (18.2 to 61.5)), but not longer term (3 or 6 months, four studies; n=147, MD 5.3 m (-12.9 to 23.4). Multiple, varied outcome measures were used (e.g. 37 studies assessing dyspnoea used 10 different scales with a lack of reporting of rate of deterioration in outcomes). Evidence gap mapping highlighted the most and least researched symptoms, as dyspnoea and cough, respectively. This evidence synthesis highlights overwhelmingly that the most researched symptom is dyspnoea and the strongest evidence base is for short-term PR. The least researched symptom was cough. Research going forward must focus on prioritising and standardising meaningful outcomes and focussing interventions on neglected symptoms.
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Affiliation(s)
- Sabrina Bajwah
- Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, London, UK,Sabrina Bajwah, Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, Bessemer Road, London SE5 9PJ, UK. E-mail:
| | | | | | | | | | - Adejoke Oluyase
- Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, London, UK
| | - Mendy Dzingina
- Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, London, UK
| | - Irene J. Higginson
- Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, London, UK
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Gillis VL, Senthinathan A, Dzingina M, Chamberlain K, Banks E, Baker MR, Longson D. Management of an acute painful sickle cell episode in hospital: summary of NICE guidance. BMJ 2012; 344:e4063. [PMID: 22740566 DOI: 10.1136/bmj.e4063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- V L Gillis
- National Institute for Health and Clinical Excellence, Manchester M1 4BD, UK
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Dzingina M, Stegenga H, Heath M, Jones D, Rogers G, Kleijnen J, Wolff R, Armstrong N, Howdle PD. [Assessment and referral after emergency treatment in suspected anaphylactic reaction: summary of the NICE guideline]. Praxis (Bern 1994) 2012; 101:473-476. [PMID: 22454309 DOI: 10.1024/1661-8157/a000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- M Dzingina
- National Institute for Health and Clincial Excellence, Piccadilly Plaza, Manchester, Grossbritannien
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Dzingina M, Stegenga H, Heath M, Jones D, Rogers G, Kleijnen J, Wolff R, Armstrong N, Howdle PD. Assessment and referral after emergency treatment of a suspected anaphylactic episode: summary of NICE guidance. BMJ 2011; 343:d7595. [PMID: 22171344 DOI: 10.1136/bmj.d7595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M Dzingina
- National Institute for Health and Clinical Excellence, Piccadilly Plaza, Manchester M1 4BT, UK
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