Objectives
Remdesivir (RDV) is the only antiviral treatment conditionally approved to treat COVID-19 hospitalized patients (1). In Mexico, RDV received an Emergency Use Authorization on March 2021 for hospitalized adults with a confirmed diagnosis of COVID-19 (2). This study assessed to conduct a CEA of the use of RDV in hospitalized patients compared to the standard of care (SoC) in the Mexican context.
Methods
A combined decision tree with a Markov model was used to perform a CEA of treated hospitalized adults for COVID-19 with RDV. In the first stage, patients were followed for 28 days during the hospital stay with a decision tree that consisted of three nodes: 1) the decision between SoC or RDV; 2) whether patients received supplementary oxygen or not during the hospital stay, and 3) whether they remain alive or died. After the 28-days follow-up, in a second stage, patients who remain alive entered on a Markov model with two mutually exclusive health states (alive or dead) with one-year cycles. Probabilities, resource utilization, and costs (e.g., cost of hospitalization, monitoring tests, complementary medicines) were extracted from public governmental sources (3–6). Health outcomes (measured as Life-Years Gained -LYG) and costs were discounted following national guidelines (7). Deterministic and probabilistic sensitivity analyses were conducted.
Results
A thousand adults were modeled. In the base case, RDV provided 0.7 more LYG and generated savings for 1,722 USD compared to SoC (0.91 LYG and -2,038 USD in probabilistic analysis). Thus, RDV is a dominant intervention to treat COVID-19. Results were consistent for all sensitivity scenarios but only for all patients with severe COVID-19 (ICER 2,386 USD), remaining as a cost-effective option.
Conclusions
Given the potential clinical benefits of RDV, the model estimated that RDV represents a cost-saving option to the Mexican health system for hospitalized patients with COVID-19.