RT Journal Article
SR Electronic
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
FD Canadian Medical Association
SP E807
OP E817
DO 10.9778/cmajo.20220077
VO 10
IS 3
A1 Vincent I. Lau
A1 Robert Fowler
A1 Ruxandra Pinto
A1 Alain Tremblay
A1 Sergio Borgia
A1 François M. Carrier
A1 Matthew P. Cheng
A1 John Conly
A1 Cecilia T. Costiniuk
A1 Peter Daley
A1 Erick Duan
A1 Madeleine Durand
A1 Patricia S. Fontela
A1 George Farjou
A1 Mike Fralick
A1 Anna Geagea
A1 Jennifer Grant
A1 Yoav Keynan
A1 Kosar Khwaja
A1 Nelson Lee
A1 Todd C. Lee
A1 Rachel Lim
A1 Conar R. O’Neil
A1 Jesse Papenburg
A1 Makeda Semret
A1 Michael Silverman
A1 Wendy Sligl
A1 Ranjani Somayaji
A1 Darrell H.S. Tan
A1 Jennifer L.Y. Tsang
A1 Jason Weatherald
A1 Cedric Philippe Yansouni
A1 Ryan Zarychanski
A1 Srinivas Murthy
A1 ,
YR 2022
UL http://www.cmajopen.ca/content/10/3/E807.abstract
AB 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