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      Cost-Effectiveness Analysis of Remdesivir Treatment in COVID-19 Patients Requiring Low-Flow Oxygen Therapy: Payer Perspective in Turkey

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          Abstract

          Introduction

          This study aims to evaluate the cost-effectiveness of remdesivir compared to other existing therapies (SoC) in Turkey to treat COVID-19 patients hospitalized with < 94% saturation and low-flow oxygen therapy (LFOT) requirement.

          Methods

          We compared remdesivir as the treatment for COVID-19 with the treatments in the Turkish treatment guidelines. Analyses were performed using data from 78 hospitalized COVID-19 patients with SpO 2 < 94% who received LFOT in a tertiary healthcare facility. COVID-19 episode costs were calculated for 78 patients considering the cost of modeled remdesivir treatment in the same group from the payer’s perspective. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) was calculated for remdesivir versus the SoC for the population identified. For Turkey, a reimbursement threshold value between USD 8599 (1 × per capita gross domestic product—GDP) and USD 25.797 (3 × GDP) per QALY was used.

          Results

          In the remdesivir arm, the length of hospital stay (LOS) was 3 days shorter than the SOC. The low ventilator requirement in the remdesivir arm was one factor that decreased the QALY disutility value. In patients who were transferred to intensive care unit (ICU) from the ward, the mean LOS was 17.3 days (SD 13.6), and the mean cost of stay was USD 155.3/day (SD 168.0), while in patients who were admitted to ICU at baseline, the mean LOS was 13.1 days (SD 13.7), and the mean cost of stay was USD 207.9/day (SD 133.6). The mean cost of episode per patient was USD 3461.1 (SD 2259.8) in the remdesivir arm and USD 3538.9 (SD 3296.0) in the SOC arm. Incremental QALYs were estimated at 0.174. Remdesivir treatment was determined to be cost saving vs. SoC.

          Conclusions

          Remdesivir, which results in shorter LOS and lower rates of intubation requirements in ICU patients than existing therapies, is associated with higher QALYs and lower costs, dominating SoC in patients with SpO 2 < 94% who require oxygen support.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s12325-021-01874-9.

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          Remdesivir for the Treatment of Covid-19 — Final Report

          John H. Beigel, Kay Tomashek, Lori Dodd … (2022)
          Abstract Background Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (Covid-19), none have yet been shown to be efficacious. Methods We conducted a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults hospitalized with Covid-19 with evidence of lower respiratory tract involvement. Patients were randomly assigned to receive either remdesivir (200 mg loading dose on day 1, followed by 100 mg daily for up to 9 additional days) or placebo for up to 10 days. The primary outcome was the time to recovery, defined by either discharge from the hospital or hospitalization for infection-control purposes only. Results A total of 1063 patients underwent randomization. The data and safety monitoring board recommended early unblinding of the results on the basis of findings from an analysis that showed shortened time to recovery in the remdesivir group. Preliminary results from the 1059 patients (538 assigned to remdesivir and 521 to placebo) with data available after randomization indicated that those who received remdesivir had a median recovery time of 11 days (95% confidence interval [CI], 9 to 12), as compared with 15 days (95% CI, 13 to 19) in those who received placebo (rate ratio for recovery, 1.32; 95% CI, 1.12 to 1.55; P<0.001). The Kaplan-Meier estimates of mortality by 14 days were 7.1% with remdesivir and 11.9% with placebo (hazard ratio for death, 0.70; 95% CI, 0.47 to 1.04). Serious adverse events were reported for 114 of the 541 patients in the remdesivir group who underwent randomization (21.1%) and 141 of the 522 patients in the placebo group who underwent randomization (27.0%). Conclusions Remdesivir was superior to placebo in shortening the time to recovery in adults hospitalized with Covid-19 and evidence of lower respiratory tract infection. (Funded by the National Institute of Allergy and Infectious Diseases and others; ACTT-1 ClinicalTrials.gov number, NCT04280705.)
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            Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial

            Yeming Wang, Dingyu Zhang, Guanhua Du … (2021)
            Summary Background No specific antiviral drug has been proven effective for treatment of patients with severe coronavirus disease 2019 (COVID-19). Remdesivir (GS-5734), a nucleoside analogue prodrug, has inhibitory effects on pathogenic animal and human coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro, and inhibits Middle East respiratory syndrome coronavirus, SARS-CoV-1, and SARS-CoV-2 replication in animal models. Methods We did a randomised, double-blind, placebo-controlled, multicentre trial at ten hospitals in Hubei, China. Eligible patients were adults (aged ≥18 years) admitted to hospital with laboratory-confirmed SARS-CoV-2 infection, with an interval from symptom onset to enrolment of 12 days or less, oxygen saturation of 94% or less on room air or a ratio of arterial oxygen partial pressure to fractional inspired oxygen of 300 mm Hg or less, and radiologically confirmed pneumonia. Patients were randomly assigned in a 2:1 ratio to intravenous remdesivir (200 mg on day 1 followed by 100 mg on days 2–10 in single daily infusions) or the same volume of placebo infusions for 10 days. Patients were permitted concomitant use of lopinavir–ritonavir, interferons, and corticosteroids. The primary endpoint was time to clinical improvement up to day 28, defined as the time (in days) from randomisation to the point of a decline of two levels on a six-point ordinal scale of clinical status (from 1=discharged to 6=death) or discharged alive from hospital, whichever came first. Primary analysis was done in the intention-to-treat (ITT) population and safety analysis was done in all patients who started their assigned treatment. This trial is registered with ClinicalTrials.gov, NCT04257656. Findings Between Feb 6, 2020, and March 12, 2020, 237 patients were enrolled and randomly assigned to a treatment group (158 to remdesivir and 79 to placebo); one patient in the placebo group who withdrew after randomisation was not included in the ITT population. Remdesivir use was not associated with a difference in time to clinical improvement (hazard ratio 1·23 [95% CI 0·87–1·75]). Although not statistically significant, patients receiving remdesivir had a numerically faster time to clinical improvement than those receiving placebo among patients with symptom duration of 10 days or less (hazard ratio 1·52 [0·95–2·43]). Adverse events were reported in 102 (66%) of 155 remdesivir recipients versus 50 (64%) of 78 placebo recipients. Remdesivir was stopped early because of adverse events in 18 (12%) patients versus four (5%) patients who stopped placebo early. Interpretation In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits. However, the numerical reduction in time to clinical improvement in those treated earlier requires confirmation in larger studies. Funding Chinese Academy of Medical Sciences Emergency Project of COVID-19, National Key Research and Development Program of China, the Beijing Science and Technology Project.
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              Mild or Moderate Covid-19

              Caren G. Solomon, Rajesh Gandhi, John Lynch … (2020)
              Article 0 comments Cited 723 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ergun Oksuz:
                ORCID: http://orcid.org/0000-0002-5723-5965
                eoksuz@baskent.edu.tr
                Simten Malhan:
                ORCID: http://orcid.org/0000-0001-9853-4753
                bmalhan@baskent.edu.tr
                Mustafa Sait Gonen:
                ORCID: http://orcid.org/0000-0002-1089-623X
                sait.gonen@iuc.edu.tr
                Zekayi Kutlubay:
                ORCID: http://orcid.org/0000-0003-0809-1624
                zekayikutlubay@hotmail.com
                Yilmaz Keskindemirci:
                ORCID: http://orcid.org/0000-0003-3637-0620
                ykeskindemirci@gmail.com
                James Jarrett: james.jarrett@gilead.com
                Toros Sahin: Toros.Sahin@gilead.com
                Gokcem Ozcagli: Gokcem.Ozcagli@gilead.com
                Ahmet Bilgic: ahmet.bilgic@gilead.com
                Merve Ozlem Bibilik: merveozlem.bibilik@gilead.com
                Fehmi Tabak:
                ORCID: http://orcid.org/0000-0001-8632-2825
                fehmitabak@hotmail.com
                Journal
                Journal ID (nlm-ta): Adv Ther
                Journal ID (iso-abbrev): Adv Ther
                Title: Advances in Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 0741-238X
                ISSN (Electronic): 1865-8652
                Publication date (Electronic): 11 August 2021
                Publication date PMC-release: 11 August 2021
                Pages: 1-14
                Affiliations
                [1 ]GRID grid.411548.d, ISNI 0000 0001 1457 1144, Department of Family Medicine, Faculty of Medicine, , Baskent University, ; Baglica Kampusu, Etimesgut, Ankara, Turkey
                [2 ]GRID grid.411548.d, ISNI 0000 0001 1457 1144, Department of Health Care Management, Faculty of Health Sciences, , Baskent University, ; Ankara, Turkey
                [3 ]GRID grid.9601.e, ISNI 0000 0001 2166 6619, Cerrahpasa Medical School, , Istanbul University, ; Istanbul, Turkey
                [4 ]GRID grid.9601.e, ISNI 0000 0001 2166 6619, Cerrahpasa Medical School Hospital, , Istanbul University, ; Istanbul, Turkey
                [5 ]GRID grid.9601.e, ISNI 0000 0001 2166 6619, Istanbul University Hospitals, ; Istanbul, Turkey
                [6 ]GRID grid.418227.a, ISNI 0000 0004 0402 1634, HEOR, Global Value and Access Europe, Gilead Sciences, ; Foster City, CA USA
                [7 ]Gilead Sciences Turkey, Istanbul, Turkey
                [8 ]GRID grid.9601.e, ISNI 0000 0001 2166 6619, Department of Infectious Disease, Cerrahpasa Medical School, , Istanbul University, ; Istanbul, Turkey
                Author information
                http://orcid.org/0000-0002-5723-5965
                http://orcid.org/0000-0001-9853-4753
                http://orcid.org/0000-0002-1089-623X
                http://orcid.org/0000-0003-0809-1624
                http://orcid.org/0000-0003-3637-0620
                http://orcid.org/0000-0001-8632-2825
                Article
                Publisher ID: 1874
                DOI: 10.1007/s12325-021-01874-9
                PMC ID: 8355577
                PubMed ID: 34379304
                SO-VID: 58fa1be1-e416-41f1-a7ab-a5c9a5484cbb
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 28 June 2021
                Date accepted : 23 July 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100005564, gilead sciences;
                Categories
                Subject: Original Research

                Keywords: remdesivir,covid-19,cost-effectiveness,qalys,length of stay,oxygen saturation
                Data availability:
                Keywords: remdesivir, covid-19, cost-effectiveness, qalys, length of stay, oxygen saturation

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