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 Lau, Vincent I.
A1 Fowler, Robert
A1 Pinto, Ruxandra
A1 Tremblay, Alain
A1 Borgia, Sergio
A1 Carrier, François M.
A1 Cheng, Matthew P.
A1 Conly, John
A1 Costiniuk, Cecilia T.
A1 Daley, Peter
A1 Duan, Erick
A1 Durand, Madeleine
A1 Fontela, Patricia S.
A1 Farjou, George
A1 Fralick, Mike
A1 Geagea, Anna
A1 Grant, Jennifer
A1 Keynan, Yoav
A1 Khwaja, Kosar
A1 Lee, Nelson
A1 Lee, Todd C.
A1 Lim, Rachel
A1 O’Neil, Conar R.
A1 Papenburg, Jesse
A1 Semret, Makeda
A1 Silverman, Michael
A1 Sligl, Wendy
A1 Somayaji, Ranjani
A1 Tan, Darrell H.S.
A1 Tsang, Jennifer L.Y.
A1 Weatherald, Jason
A1 Yansouni, Cedric Philippe
A1 Zarychanski, Ryan
A1 Murthy, Srinivas
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