Cost-effectiveness Analysis of Nirmatrelvir/Ritonavir Compared with Molnupiravir in Patients at High Risk for Progression to Severe COVID-19 in Japan.

Background

Nirmatrelvir/ritonavir (NMV/r) and molnupiravir are oral antiviral drugs approved for the treatment of early symptomatic patients with mild to moderate COVID-19 at high risk of progression to severe disease in Japan.

Objective

This study evaluated, from a Japanese payer perspective, the cost-effectiveness of NMV/r compared with molnupiravir among patients with COVID-19.

Methods

This cost-effectiveness model describes the COVID-19 disease history and the impact of antiviral treatment on short-term and long-term outcomes. Nirmatrelvir/ritonavir was compared with molnupiravir, and in the scenario analysis NMV/r was compared with standard of care over a lifetime horizon.

Results

When compared with molnupiravir, NMV/r showed higher quality-adjusted life years (QALYs) (15.752 vs 15.739) and higher total cost (¥6 248 014 vs ¥6 245 829 [US 44   136.86 v s 44 121.42]). The incremental cost-effectiveness ratio was ¥164 934 (US 1165.12 ) p e r Q A L Y g a i n e d , w h i c h w a s l o w e r t h a n t h e w i l l i n g n e s s - t o - p a y ( W T P ) t h r e s h o l d i n J a p a n ( ¥ 5   000   000 / Q A L Y [ U S 35 320.71/QALY]). In the scenario analysis, the incremental cost-effectiveness ratio was ¥3 646 821 (US 25   761.66 ) p e r Q A L Y g a i n e d . O n e - w a y s e n s i t i v i t y a n a l y s i s a n d p r o b a b i l i s t i c s e n s i t i v i t y a n a l y s i s s h o w e d t h a t N M V / r w a s c o s t - e f f e c t i v e c o m p a r e d w i t h m o l n u p i r a v i r a n d s t a n d a r d o f c a r e c o n s i s t e n t l y . A l l r e s u l t s o f o n e - w a y s e n s i t i v i t y a n a l y s i s s h o w e d t h a t t h e i n c r e m e n t a l c o s t - e f f e c t i v e n e s s r a t i o s w e r e b e l o w t h e W T P t h r e s h o l d i n J a p a n . T h e r e s u l t o f t h e c o s t - e f f e c t i v e n e s s a c c e p t a b i l i t y c u r v e s h o w e d t h a t t h e p r o b a b i l i t y t h a t t h e i n c r e m e n t a l c o s t - e f f e c t i v e n e s s r a t i o w a s b e l o w t h e W T P o f ¥ 5   000   000 / Q A L Y ( U S 35 320.71/QALY) was 100.00%.

Conclusion

Nirmatrelvir/ritonavir is cost-effective compared with molnupiravir and standard of care from a Japanese payer perspective. This study provides evidence for the cost-effectiveness of NMV/r for patients with COVID-19.