Treatment of moderate to severe respiratory COVID-19: a cost-utility analysis

Autor: Rhea Varughese, Stephen E. Congly, Lynora Saxinger, Fiona Clement, Crystal E. Brown
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Cost effectiveness
medicine.medical_treatment
Cost-Benefit Analysis
Severity of Illness Index
Dexamethasone
Antimicrobial therapy
Health care rationing
Health care
Intubation
Respiratory system
health care economics and organizations
Alanine
Health Care Rationing
Multidisciplinary
Cost–benefit analysis
Health Care Costs
Health care economics
Middle Aged
Intensive Care Units
Treatment Outcome
Infectious diseases
Medicine
Quality-Adjusted Life Years
medicine.drug
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19)
Science
Clinical Decision-Making
Article
Intensive care
Severity of illness
medicine
Humans
Computer Simulation
Respiratory tract diseases
Cost–utility analysis
SARS-CoV-2
business.industry
COVID-19
Respiration
Artificial
Adenosine Monophosphate
United States
COVID-19 Drug Treatment
Quality-adjusted life year
Oxygen
Emergency medicine
business
Zdroj: Scientific Reports, Vol 11, Iss 1, Pp 1-7 (2021)
Scientific Reports
ISSN: 2045-2322
Popis: BackgroundDue to COVID-19’s significant morbidity and mortality, identifying the most cost-effective pharmacologic treatment strategy is critical. As such, we determined the most cost-effective strategy for moderate to severe COVID-19 respiratory infections using the United States health care system as a representative model.MethodsA decision analytic model modelled a base case scenario of a 60-year-old patient admitted to hospital with COVID-19. Patients requiring oxygen were considered moderate severity, and patients with severe COVID-19 required intubation with intensive care. Strategies modelled included giving remdesivir to all patients, remdesivir in severe infections, remdesivir in moderate infections, dexamethasone to all patients, dexamethasone in severe infections, remdesivir in moderate/dexamethasone in severe infections, and best supportive care. Data for the model came from the published literature. The time horizon was 1 year; no discounting was performed due to the short duration. The perspective was of the payer in the United States health care system.ResultsSupportive care for moderate/severe COVID-19 cost $11,112.98/0.8256 QALY. Remdesivir in moderate/dexamethasone in severe infections was the most cost-effective with an incremental cost-effectiveness ratio of $19,764.56/QALY gained compared to supportive care. Probabilistic sensitivity analyses showed remdesivir for moderate/dexamethasone for severe COVID-19 infection was most cost-effective in 88.6% of scenarios and dexamethasone in moderate-severe infections in 11.4% of scenarios. With lower willingness to pay thresholds ($250-$37,500), dexamethasone for severe infections was favoured.ConclusionsRemdesivir for moderate/dexamethasone for severe COVID-19 infections was the0020most cost-effective strategy. Further data is required for remdesivir to better assess its cost effectiveness in treatment of COVID-19.
Databáze: OpenAIRE
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