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COVID-19: Original Article
Model-based cost-effectiveness analysis of oral antivirals against SARS-CoV-2 in Korea
Youngji Jo, Sun Bean Kim, Munkhzul Radnaabaatar, Kyungmin Huh, Jin-Hong Yoo, Kyong Ran Peck, Hojun Park, Jaehun Jung
Epidemiol Health. 2022;44:e2022034.   Published online March 12, 2022
DOI: https://doi.org/10.4178/epih.e2022034
  • 9,041 View
  • 623 Download
  • 8 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Many countries have authorized the emergency use of oral antiviral agents for patients with mild-to-moderate cases of coronavirus disease 2019 (COVID-19). We assessed the cost-effectiveness of these agents for reducing the number of severe COVID-19 cases and the burden on Korea’s medical system.
METHODS
Using an existing model, we estimated the number of people who would require hospital/intensive care unit (ICU) admission in Korea in 2022. The treatment scenarios included (1) all adult patients, (2) elderly patients only, and (3) adult patients with underlying diseases only, compared to standard care. Based on the current health system capacity, we calculated the incremental costs per severe case averted and hospital admission for each scenario.
RESULTS
We estimated that 236,510 COVID-19 patients would require hospital/ICU admission in 2022 with standard care only. Nirmatrelvir/ritonavir (87% efficacy) was predicted to reduce this number by 80%, 24%, and 17% when targeting all adults, adults with underlying diseases, and elderly patients (25, 8, and 4%, respectively, for molnupiravir, with 30% efficacy). Nirmatrelvir/ritonavir use is likely to be cost-effective, with predicted costs of US$8,878, US$8,964, and US$1,454, per severe patient averted for the target groups listed above, respectively, while molnupiravir is likely to be less cost-effective, with costs of US$28,492, US$29,575, and US$7,915, respectively.
CONCLUSIONS
In Korea, oral treatment using nirmatrelvir/ritonavir for symptomatic COVID-19 patients targeting elderly patients would be highly cost-effective and would substantially reduce the demand for hospital admission to below the capacity of the health system if targeted to all adult patients instead of standard care.
Summary
Korean summary
본 연구는 감염병 수리모형을 바탕으로 두가지 항바이러스제의 (nirmatrelvir/ritonavir와 molnupiravir) 비용 효익을 평가하였다. 본 모델에 따르면, 2022년 한국에서, 현재 의료시스템의 수용한계를 넘는 코로나 19 대유행이 발생할 때, nirmatrelvir/ritonavir 를 코로나 감염 및 증상 있는 고령층 환자들을 대상으로 투여할 경우 높은 비용 효익이 기대되고 (중증환자 1명 감소효과에$1,454 비용소요), 성인 환자 대상으로 투여할 경우, (molnupiravir이나 nirmatrelvir/ritonavir를 투여하지 않는) 일반 치료에 비해서 전체 입원 수요를 80% 줄일 것으로 기대된다.
Key Message
Given an expected high epidemic resurgence in 2022 that could exceed South Korea’s current health system capacity, oral treatment using nirmatrelvir/ritonavir for symptomatic COVID-19 patients may be a highly cost-effective solution if targeted to elderly patients ($1,454 per severe case averted) and substantially reduce the demand for hospital admission (80%, 188,478 patients) below the capacity of the health system if targeted to all adult patients compared to standard care.

Citations

Citations to this article as recorded by  
  • Impact of the Use of Oral Antiviral Agents on the Risk of Hospitalization in Community Coronavirus Disease 2019 Patients (COVID-19)
    Terry Cheuk-Fung Yip, Grace Chung-Yan Lui, Mandy Sze-Man Lai, Vincent Wai-Sun Wong, Yee-Kit Tse, Bosco Hon-Ming Ma, Elsie Hui, Maria K W Leung, Henry Lik-Yuen Chan, David Shu-Cheong Hui, Grace Lai-Hung Wong
    Clinical Infectious Diseases.2023; 76(3): e26.     CrossRef
  • Nirmatrelvir plus ritonavir in COVID-19: a profile of its use
    Hannah A. Blair
    Drugs & Therapy Perspectives.2023; 39(2): 41.     CrossRef
  • Multi-Faceted Analysis of COVID-19 Epidemic in Korea Considering Omicron Variant: Mathematical Modeling-Based Study
    Youngsuk Ko, Victoria May Mendoza, Renier Mendoza, Yubin Seo, Jacob Lee, Jonggul Lee, Donghyok Kwon, Eunok Jung
    Journal of Korean Medical Science.2022;[Epub]     CrossRef
  • Adjusting non-pharmaceutical interventions based on hospital bed capacity using a multi-operator differential evolution
    Victoria May P. Mendoza, Renier Mendoza, Jongmin Lee, Eunok Jung
    AIMS Mathematics.2022; 7(11): 19922.     CrossRef
  • The Possible Impact of Nationwide Vaccination on Outcomes of the COVID-19 Epidemic in North Korea: A Modelling Study
    Sung-mok Jung, Jaehun Jung
    Journal of Korean Medical Science.2022;[Epub]     CrossRef
  • Medications for early treatment of COVID ‐19 in Australia
    Adam Polkinghorne, James M Branley
    Medical Journal of Australia.2022;[Epub]     CrossRef
  • Comparative effectiveness of sotrovimab and molnupiravir for prevention of severe covid-19 outcomes in patients in the community: observational cohort study with the OpenSAFELY platform
    Bang Zheng, Amelia C A Green, John Tazare, Helen J Curtis, Louis Fisher, Linda Nab, Anna Schultze, Viyaasan Mahalingasivam, Edward P K Parker, William J Hulme, Sebastian C J Bacon, Nicholas J DeVito, Christopher Bates, David Evans, Peter Inglesby, Henry D
    BMJ.2022; : e071932.     CrossRef
  • Treatment Options for Patients With Mild-to-Moderate Coronavirus Disease 2019 in Korea
    Jaehyun Jeon, BumSik Chin
    Journal of Korean Medical Science.2022;[Epub]     CrossRef
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