TY - JOUR T1 - Cost-effectiveness of remdesivir plus usual care versus usual care alone for hospitalized patients with COVID-19: an economic evaluation as part of the Canadian Treatments for COVID-19 (CATCO) randomized clinical trial JF - CMAJ Open JO - CMAJ SP - E807 LP - E817 DO - 10.9778/cmajo.20220077 VL - 10 IS - 3 AU - Vincent I. Lau AU - Robert Fowler AU - Ruxandra Pinto AU - Alain Tremblay AU - Sergio Borgia AU - François M. Carrier AU - Matthew P. Cheng AU - John Conly AU - Cecilia T. Costiniuk AU - Peter Daley AU - Erick Duan AU - Madeleine Durand AU - Patricia S. Fontela AU - George Farjou AU - Mike Fralick AU - Anna Geagea AU - Jennifer Grant AU - Yoav Keynan AU - Kosar Khwaja AU - Nelson Lee AU - Todd C. Lee AU - Rachel Lim AU - Conar R. O’Neil AU - Jesse Papenburg AU - Makeda Semret AU - Michael Silverman AU - Wendy Sligl AU - Ranjani Somayaji AU - Darrell H.S. Tan AU - Jennifer L.Y. Tsang AU - Jason Weatherald AU - Cedric Philippe Yansouni AU - Ryan Zarychanski AU - Srinivas Murthy A2 - , Y1 - 2022/07/01 UR - http://www.cmajopen.ca/content/10/3/E807.abstract N2 - Background: The role of remdesivir in the treatment of hospitalized patients with COVID-19 remains ill-defined. We conducted a cost-effectiveness analysis alongside the Canadian Treatments for COVID-19 (CATCO) open-label, randomized clinical trial evaluating remdesivir.Methods: Patients with COVID-19 in Canadian hospitals from Aug. 14, 2020, to Apr. 1, 2021, were randomly assigned to receive remdesivir plus usual care versus usual care alone. Taking a public health care payer’s perspective, we collected in-hospital outcomes and health care resource utilization alongside estimated unit costs in 2020 Canadian dollars over a time horizon from randomization to hospital discharge or death. Data from 1281 adults admitted to 52 hospitals in 6 Canadian provinces were analyzed.Results: The total mean cost per patient was $37 918 (standard deviation [SD] $42 413; 95% confidence interval [CI] $34 617 to $41 220) for patients randomly assigned to the remdesivir group and $38 026 (SD $46 021; 95% CI $34 480 to $41 573) for patients receiving usual care (incremental cost −$108 [95% CI −$4953 to $4737], p > 0.9). The difference in proportions of in-hospital deaths between remdesivir and usual care groups was −3.9% (18.7% v. 22.6%, 95% CI −8.3% to 1.0%, p = 0.09). The difference in proportions of incident invasive mechanical ventilation events between groups was −7.0% (8.0% v. 15.0%, 95% CI −10.6% to −3.4%, p = 0.006), whereas the difference in proportions of total mechanical ventilation events between groups was −5.7% (16.4% v. 22.1%, 95% CI −10.0% to −1.4%, p = 0.01). Remdesivir was the dominant intervention (but only marginally less costly, with mildly lower mortality) with an incalculable incremental cost effectiveness ratio; we report results of incremental costs and incremental effects separately. For willingness-to-pay thresholds of $0, $20 000, $50 000 and $100 000 per death averted, a strategy using remdesivir was cost-effective in 60%, 67%, 74% and 79% of simulations, respectively. The remdesivir costs were the fifth highest cost driver, offset by shorter lengths of stay and less mechanical ventilation.Interpretation: From a health care payer perspective, treating patients hospitalized with COVID-19 with remdesivir and usual care appears to be preferrable to treating with usual care alone, albeit with marginal incremental cost and small clinical effects. The added cost of remdesivir was offset by shorter lengths of stay in the intensive care unit and less need for ventilation. Study registration: ClinicalTrials. gov, no. NCT04330690 ER -