Cost-effectiveness Analysis of Nirmatrelvir/Ritonavir for COVID-19 Among Individuals at High Risk: A Modeling Study - Scorecard - 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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Clinical Scorecard: Economic Evaluation of Nirmatrelvir/Ritonavir for High-Risk COVID-19 Patients: A Modeling Approach

At a Glance

CategoryDetail
ConditionCOVID-19 in high-risk individuals
Key MechanismsNirmatrelvir/ritonavir is an oral protease inhibitor administered within 5 days of symptom onset to reduce risk of severe disease
Target PopulationIndividuals at high risk for severe COVID-19 due to immunocompromised status, obesity, diabetes, older age, or other comorbidities
Care SettingOutpatient treatment for mild COVID-19 in high-risk patients

Key Highlights

  • Nirmatrelvir/ritonavir reduces hospitalizations by 21% to 89% and mortality by 34% to 82% depending on effectiveness scenario
  • Cost-effectiveness depends on drug price and baseline hospitalization/ICU rates; cost-effective pricing estimated <$512 (low effectiveness) to <$1071 (high effectiveness)
  • Current low baseline hospitalization rates limit cost-effectiveness unless drug price is reduced by 22% to 63%

Guideline-Based Recommendations

Diagnosis

  • Identify high-risk individuals with mild COVID-19 within 5 days of symptom onset for potential treatment

Management

  • Administer nirmatrelvir/ritonavir to high-risk patients early to prevent severe disease
  • Consider extended treatment courses in severely immunocompromised patients to improve efficacy

Monitoring & Follow-up

  • Monitor hospitalization and ICU admission rates to assess treatment impact
  • Evaluate uptake levels to optimize clinical outcomes

Risks

  • Potential slow uptake limits population-level benefits
  • Cost and pricing impact accessibility and cost-effectiveness

Patient & Prescribing Data

949 high-risk individuals infected with SARS-CoV-2, median age 65, with comorbidities including obesity, hematologic malignancy, transplantation, and immunosuppressive medication use

Assuming 100% uptake, nirmatrelvir/ritonavir reduces hospitalizations and deaths; effectiveness and drug price critically influence cost-effectiveness

Clinical Best Practices

  • Initiate nirmatrelvir/ritonavir within 5 days of symptom onset in high-risk patients
  • Assess patient risk factors including immunocompromised status and comorbidities before prescribing
  • Consider cost-effectiveness thresholds and drug pricing in treatment decisions
  • Encourage policy reevaluation of drug pricing to improve access and cost-effectiveness

References

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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