Clinical Scorecard: Economic Implications of Implementing Nirmatrelvir-Ritonavir for COVID-19 Treatment in a Major Integrated Healthcare Network
At a Glance
Category
Detail
Condition
COVID-19 in high-risk adult patients
Key Mechanisms
Oral antiviral reducing risk of hospitalization and death by inhibiting viral replication
Target Population
Veterans Health Administration (VHA) enrolled adults with laboratory-confirmed COVID-19 and at least one risk factor for severe illness
Care Setting
Outpatient treatment within an integrated healthcare system (VHA)
Key Highlights
Nirmatrelvir-ritonavir (NR) reduced hospitalization or death risk by 27% among all treatment-eligible Veterans in real-world VHA data.
Treating all eligible Veterans with NR increased total budget costs by $122 million due to drug purchasing costs despite reducing healthcare utilization costs by $20 million.
Targeted treatment of highest risk quartile patients achieved healthcare cost savings with minimal total budget increase, supporting risk-informed allocation.
Guideline-Based Recommendations
Diagnosis
Identify treatment-eligible patients with laboratory-confirmed COVID-19 and at least one risk factor for severe disease.
Management
Prescribe NR within 5 days of symptom onset for outpatient treatment of mild-to-moderate COVID-19 in high-risk adults.
Consider risk stratification to prioritize NR treatment for patients in the highest risk quartile to maximize cost-effectiveness.
Monitoring & Follow-up
Monitor for emergency department visits, hospitalizations, and mortality within 30 days post-treatment initiation.
Risks
Be aware of contraindications including advanced renal or hepatic disease and drug interactions.
Consider variable treatment benefit depending on patient risk profile and population immunity.
Patient & Prescribing Data
138,261 treatment-eligible Veterans; 18% (24,892) received NR between April 2022 and March 2023.
Broad treatment increased budget costs substantially; targeted treatment of highest risk patients yielded cost savings and minimized budget impact.
Clinical Best Practices
Use multivariate risk prediction models to stratify patients by hospitalization or death risk before prescribing NR.
Prioritize NR treatment for patients in the highest risk quartile to optimize healthcare cost savings and budget impact.
Initiate NR treatment promptly within 5 days of symptom onset to align with clinical trial protocols.
Consider cost implications and advocate for price reductions to improve NR financial viability in healthcare systems.
by David P Bui, Denise M Hynes, Edwin Wong, Robert Vergun, Lei Yan, Yuli Li, Nallakkandi Rajeevan, Kristin Berry, Hung-Mo Lin, Yuan Huang, Diana J Govier, Mihaela Aslan, George Ioannou, Kristina L Bajema
A global systematic review of 173 studies found differing associations between COVID-19 infection and vaccination and retinal vascular events, with retinal artery occlusion more common after infection and retinal vein occlusion more common after vaccination.
