Economic evaluation of remdesivir for the treatment of severe COVID-19 patients in China under different scenarios.

OBJECTIVE: The present study aimed to evaluate the cost-effectiveness of the 5-day remdesivir regimen compared with standard of care (SoC) among severe COVID-19 patients in China, the evidence on which is essential to inform the necessity of securing access to remdesivir.

METHODS: A dynamic transmission model that extended the susceptible-exposed-infected-recovered framework by incorporating asymptomatic, presymptomatic, and waiting-to-diagnosed patients was constructed to conduct the cost-effectiveness analysis from the healthcare system perspective. To estimate epidemic parameters, the model was first calibrated to the observed epidemic curve in Wuhan from Jan 23 to Mar 19, 2020. Following the calibration, the infected compartment was replaced by three severity-defined health states to reflect differential costs and quality of life associated with disease gravity. Costs and quality-adjusted life year (QALY) outcomes of nine million simulated people were accrued across time to evaluate the incremental cost-effectiveness ratio (ICER) of remdesivir. As robustness checks, an alternative modeling technique using decision tree, additional epidemic scenarios representing different epidemic intensities, and one-way parameter variations were also analyzed.

RESULTS: Remdesivir treatment cost CN¥97.93 million more than SoC. Also, the net QALY gain from 5-day remdesivir treatment was 6,947 QALYs. As such, the ICER was CN¥14,098/QALY, substantially lower than the once the gross domestic product per capita threshold. More, the peak daily number of severe cases was 19% lower in the remdesivir treatment strategy. Overall, results were robust in alternative scenarios and sensitivity analyses.

CONCLUSIONS: Given the cost-effectiveness profile, access to remdesivir for severe COVID-19 patients in China should be considered.