Cost-effectiveness analysis of nirmatrelvir/ritonavir in adult patients at high risk of progressing to severe COVID-19
Objective: This study aimed to estimate the cost-effectiveness of nirmatrelvir/ritonavir (NMV/r) versus the standard of care (SoC) for patients with mild-to-moderate coronavirus disease 2019 (COVID-19) at high risk for progression to severe illness from the perspective of the Italian National Healt...
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2025-07-01
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| Series: | Global & Regional Health Technology Assessment |
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| Online Access: | https://journals.aboutscience.eu/index.php/grhta/article/view/3403 |
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| author | Carolina Moreno Andrea Aiello Roberto Di Virgilio Valentina Mazzotta Andrea Antinori |
| author_facet | Carolina Moreno Andrea Aiello Roberto Di Virgilio Valentina Mazzotta Andrea Antinori |
| author_sort | Carolina Moreno |
| collection | DOAJ |
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Objective: This study aimed to estimate the cost-effectiveness of nirmatrelvir/ritonavir (NMV/r) versus the standard of care (SoC) for patients with mild-to-moderate coronavirus disease 2019 (COVID-19) at high risk for progression to severe illness from the perspective of the Italian National Health Service.
Methods: A cost-effectiveness model was developed using a closed cohort of 1,000 infected patients. It employed
a short-term decision tree (1 year) followed by a lifetime 2-state Markov model (alive and dead). The
short-term decision tree captured costs and outcomes associated with the primary infection and healthcare utilization; survivors of the short-term decision tree were followed until death to calculate Italian quality-adjusted
life years (QALYs), adjusted in the short-term for survivors to mechanical ventilation. Baseline hospitalization rate
and NMV/r effectiveness were sourced from the Istituto Superiore di Sanità (ISS) and the randomized clinical trial
Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients (EPIC-HR), respectively. Other inputs were
given by previous COVID-19 studies and publicly available sources. Sensitivity analyses were conducted for all
model inputs to test the robustness of the results of the model.
Results: NMV/r presented an advantageous cost-effectiveness ratio of 2,237 €/QALY, compared to the SoC, in the
long-term horizon (30 years). Results were most sensitive to baseline risk of hospitalization and NMV/r treatment
effectiveness parameters. The probabilistic analysis indicated that NMV/r has a 100% probability of being costeffective at a 33,004 € willingness-to-pay threshold.
Conclusions: From the Italian National Health Service perspective, NMV/r is cost-effective compared to the standard of care for patients at high risk for severe COVID-19.
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| format | Article |
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| issn | 2284-2403 2283-5733 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | AboutScience Srl |
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| series | Global & Regional Health Technology Assessment |
| spelling | doaj-art-bdfff03896b44cf8a9f17a878996d4e52025-07-17T14:21:48ZengAboutScience SrlGlobal & Regional Health Technology Assessment2284-24032283-57332025-07-0111110.33393/grhta.2024.3403Cost-effectiveness analysis of nirmatrelvir/ritonavir in adult patients at high risk of progressing to severe COVID-19Carolina Moreno0Andrea Aiello1Roberto Di Virgilio2Valentina Mazzotta3Andrea Antinori4PharmaLex Italy SpA, Milano - ItalyPharmaLex Italy SpA, Milano - ItalyPfizer Italia, Roma - ItalyNational Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma - ItalyNational Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma - Italy Objective: This study aimed to estimate the cost-effectiveness of nirmatrelvir/ritonavir (NMV/r) versus the standard of care (SoC) for patients with mild-to-moderate coronavirus disease 2019 (COVID-19) at high risk for progression to severe illness from the perspective of the Italian National Health Service. Methods: A cost-effectiveness model was developed using a closed cohort of 1,000 infected patients. It employed a short-term decision tree (1 year) followed by a lifetime 2-state Markov model (alive and dead). The short-term decision tree captured costs and outcomes associated with the primary infection and healthcare utilization; survivors of the short-term decision tree were followed until death to calculate Italian quality-adjusted life years (QALYs), adjusted in the short-term for survivors to mechanical ventilation. Baseline hospitalization rate and NMV/r effectiveness were sourced from the Istituto Superiore di Sanità (ISS) and the randomized clinical trial Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients (EPIC-HR), respectively. Other inputs were given by previous COVID-19 studies and publicly available sources. Sensitivity analyses were conducted for all model inputs to test the robustness of the results of the model. Results: NMV/r presented an advantageous cost-effectiveness ratio of 2,237 €/QALY, compared to the SoC, in the long-term horizon (30 years). Results were most sensitive to baseline risk of hospitalization and NMV/r treatment effectiveness parameters. The probabilistic analysis indicated that NMV/r has a 100% probability of being costeffective at a 33,004 € willingness-to-pay threshold. Conclusions: From the Italian National Health Service perspective, NMV/r is cost-effective compared to the standard of care for patients at high risk for severe COVID-19. https://journals.aboutscience.eu/index.php/grhta/article/view/3403Cost-effectiveness analysisCost-utility analysisCOVID-19Italynirmatrelvir/ritonavir |
| spellingShingle | Carolina Moreno Andrea Aiello Roberto Di Virgilio Valentina Mazzotta Andrea Antinori Cost-effectiveness analysis of nirmatrelvir/ritonavir in adult patients at high risk of progressing to severe COVID-19 Global & Regional Health Technology Assessment Cost-effectiveness analysis Cost-utility analysis COVID-19 Italy nirmatrelvir/ritonavir |
| title | Cost-effectiveness analysis of nirmatrelvir/ritonavir in adult patients at high risk of progressing to severe COVID-19 |
| title_full | Cost-effectiveness analysis of nirmatrelvir/ritonavir in adult patients at high risk of progressing to severe COVID-19 |
| title_fullStr | Cost-effectiveness analysis of nirmatrelvir/ritonavir in adult patients at high risk of progressing to severe COVID-19 |
| title_full_unstemmed | Cost-effectiveness analysis of nirmatrelvir/ritonavir in adult patients at high risk of progressing to severe COVID-19 |
| title_short | Cost-effectiveness analysis of nirmatrelvir/ritonavir in adult patients at high risk of progressing to severe COVID-19 |
| title_sort | cost effectiveness analysis of nirmatrelvir ritonavir in adult patients at high risk of progressing to severe covid 19 |
| topic | Cost-effectiveness analysis Cost-utility analysis COVID-19 Italy nirmatrelvir/ritonavir |
| url | https://journals.aboutscience.eu/index.php/grhta/article/view/3403 |
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