Cost-effectiveness Analysis of Nirmatrelvir/Ritonavir for COVID-19 Among Individuals at High Risk: A Modeling Study - Report - MDSpire

Cost-effectiveness Analysis of Nirmatrelvir/Ritonavir for COVID-19 Among Individuals at High Risk: A Modeling Study

  • By

  • Emma Birnie

  • Magda Vergouwe

  • Brent Appelman

  • Jason J Biemond

  • Jarom Heijmans

  • Brooke E Nichols

  • W Joost Wiersinga

  • Stephanie Popping

  • on behalf of

  • the TURN-COVID studygroup

  • Matthijs R A Welkers

  • Hans L Zaaijer

  • Frans J van Ittersum

  • Maarten F Schim van der Loeff

  • Marije K Bomers

  • Marie José Kersten

  • Mette D Hazenberg

  • Marc van der Valk

  • E Marleen Kemper

  • Frits R Rosendaal

  • Mark G J de Boer

  • Renée A Douma

  • Marcel van den Berge

  • Robert-Jan Hassing

  • Heidi S M Amerlaan

  • Marit G A van Vonderen

  • Janneke E Stalenhoef

  • Robin Soetekouw

  • Frank van de Veerdonk

  • Marvin A H Berrevoets

  • Robbert J van Alphen

  • Frits van Osch

  • Jiri F P Wagenaar

  • Rob J van Marum

  • Astrid M L Oude Lashof

  • Cees van Nieuwkoop

  • Eliane M S Leyten

  • Hazra S Moeniralam

  • Joost N Vermeulen

  • March 26, 2025

  • 0 min

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Economic Evaluation of Nirmatrelvir/Ritonavir for High-Risk COVID-19 Patients

Overview

This study used a decision-analytic model to evaluate the health outcomes and cost-effectiveness of nirmatrelvir/ritonavir (nirmatrelvir/r) in high-risk COVID-19 patients in the Netherlands. Results indicate that nirmatrelvir/r can reduce hospitalizations and deaths substantially, with cost-effectiveness dependent on drug price and effectiveness assumptions.

Background

SARS-CoV-2 continues to pose a risk of severe disease, especially in individuals with immunocompromised status or comorbidities such as obesity and diabetes. Nirmatrelvir/ritonavir, an oral protease inhibitor, is currently used to prevent severe COVID-19 in high-risk patients when administered early. Despite clinical evidence supporting its efficacy, uptake remains limited and cost-effectiveness varies across settings. This study aims to inform policy by modeling health outcomes and economic impact during the Omicron wave in the Netherlands.

Data Highlights

ParameterValue
Sample size949 high-risk individuals
Median age (IQR)65 years (53–75)
Female participants44%
ComorbiditiesObesity 25%, Hematologic malignancy 21%, Transplantation 17%, Immunosuppressive medication 47%
Baseline hospitalization rate1%
Baseline ICU admission rate0.05%
Drug price range evaluated$275–$1375 per 5-day course
Effectiveness scenariosLow: 21% hospitalization RR reduction, 34% mortality RR reduction; High: 89% hospitalization RR reduction, 82% mortality RR reduction
Cost-effectiveness threshold<$88,000 per QALY gained
Cost-effective price thresholds<$512 (low effectiveness), <$1071 (high effectiveness)

Key Findings

  • Nirmatrelvir/r reduces hospitalizations by 21% to 89% and deaths by 44% to 90%, depending on effectiveness assumptions.
  • Cost-effectiveness is sensitive to baseline hospitalization and ICU admission rates, drug price, and treatment effectiveness.
  • At current baseline event rates, nirmatrelvir/r is cost-effective if priced below $512 (low effectiveness) or $1071 (high effectiveness).
  • Current drug price in the Netherlands (~$1375) exceeds cost-effective thresholds, suggesting a need for price reduction between 22% and 63%.
  • Uptake level influences clinical outcomes, with higher uptake leading to greater reductions in hospitalizations and deaths.
  • Findings support reevaluation of drug pricing to optimize clinical and economic benefits in high-risk populations.

Clinical Implications

Clinicians and policymakers should consider the cost-effectiveness thresholds identified when prescribing nirmatrelvir/r to high-risk COVID-19 patients. Reducing drug price could enhance access and maximize health benefits by preventing severe outcomes. Monitoring uptake and targeting patients with higher baseline risk may further improve clinical and economic outcomes.

Conclusion

Nirmatrelvir/ritonavir has the potential to reduce severe COVID-19 outcomes cost-effectively in high-risk patients if priced appropriately. These results highlight the importance of ongoing evaluation of drug pricing and utilization strategies to optimize patient care and resource allocation.

References

  1. Author/Source/Year -- Economic Evaluation of Nirmatrelvir/Ritonavir for High-Risk COVID-19 Patients: A Modeling Approach

Original Source(s)

Cost-effectiveness Analysis of Nirmatrelvir/Ritonavir for COVID-19 Among Individuals at High Risk: A Modeling Study

  • by Emma Birnie, Magda Vergouwe, Brent Appelman, Jason J Biemond, Jarom Heijmans, Brooke E Nichols, W Joost Wiersinga, Stephanie Popping, on behalf of, the TURN-COVID studygroup, Matthijs R A Welkers, Hans L Zaaijer, Frans J van Ittersum, Maarten F Schim van der Loeff, Marije K Bomers, Marie José Kersten, Mette D Hazenberg, Marc van der Valk, E Marleen Kemper, Frits R Rosendaal, Mark G J de Boer, Renée A Douma, Marcel van den Berge, Robert-Jan Hassing, Heidi S M Amerlaan, Marit G A van Vonderen, Janneke E Stalenhoef, Robin Soetekouw, Frank van de Veerdonk, Marvin A H Berrevoets, Robbert J van Alphen, Frits van Osch, Jiri F P Wagenaar, Rob J van Marum, Astrid M L Oude Lashof, Cees van Nieuwkoop, Eliane M S Leyten, Hazra S Moeniralam, Joost N Vermeulen

  • March 26, 2025

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