ABSTRACT
Background: A need exists for safe, affordable, and effective antiviral treatments for less severe COVID-19 outpatients that can prevent infection progression, hospitalization, and death;shorten the time to clinical recovery;and reduce transmission. In our best knowledge, there are not, so far, costeffectiveness analysis on oral antiviral COVID-19 drugs in Spain. In our study we aim to evaluate cost-effectiveness of oral nirmatrelvir plus ritonavir in COVID-19 mild to moderate outpatients with at least one risk factor for disease progression in Spain. Method(s): A simulation model was constructed in R, to assess the clinical consequences and costs associated with COVID-19 in a hypothetical cohort of non-hospitalized patients older than 65 years with mild-to-moderate COVID and at least one risk factor for progression in Spain. The intervention assessed was nirmatrelvir plus ritonavir 300 mg plus 100mg every 12 hours up to 5 days. The comparator was symptomatic treatment with no antiviral drugs against SARSCoV- 2. The study was contextualized in the Spanish National Health System and the perspective of the service provider was adopted. Quality of life adjusted life years (QALYs) was used as a measure of effectiveness. Drug effectiveness was obtained from a literature review. As a cost measure, the retail price of the drugs was used. As a threshold willing to pay, the Spanish Gross National Product per capita was used. A discount of 3% per year was applied on future health effects. We used a decisional tree model. A univariate sensitivity analysis and probabilistic sensitivity analysis was performed. Result(s): We found that nirmatrelvir/ritonavir yielded an extra 620.89 QALYs compared to a baseline scenario without it, at an increase in cost of 89,630,442 with an Incremental cost-effectiveness ratio of 144,356.4 /QALY gained. One way sensitivity analysis and probabilistic sensitivity analysis using Monte-Carlo simulations were undertaken and showed that the probability of not being costeffective was 1 at the current price and willingness to pay threshold. To meet our willingness to pay threshold, nirmatrelvir plus ritonavir 5-days treatment price should be lowered down to 70 . Conclusion(s): According to our analysis nirmatrelvir/ritonavir is not costeffective in in the Spanish National Health System for outpatients older than 65 years with at least one risk factor for COVID progression. A drug price of 70 per treatment would meet our willingness to pay threshold.
ABSTRACT
Objective: It is unclear to which extent the higher mortality associated with hypertension in the coronavirus disease (COVID-19) is due to its increased prevalence among older patients or to speci fic mechanisms. The main objective of the study is to analyze whether HT represents an independent risk factor for death as a hard endpoint in patients hospitalized with SARS-CoV-2 in Spain Design and method: Cross-sectional, observational, retrospective multicenter study, analyzing 12226 patients who required hospital admission in 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics of survivors versus non-survivors Results: The mean age of the study population was 67.5 ± 16.1 years, 42.6% were women. Overall, 2630 (21.5%) subjects died. The most common comorbidity was hypertension (50.9%) followed by diabetes (19.1%), and atrial fibrillation (11.2%). Multivariate analysis showed that after adjusting for gender (males OR: 1.5, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), and Charlson Comorbidity Index scores (second and third tertiles OR: 4.7 and 8.1, p = 0.0001), hypertension was signi ficantly predictive of allcause mortality when this comorbidity was treated with angiotensin-converting enzyme inhibitors (ACEIs) (OR: 1.6, p = 0.002) or other than renin-angiotensinaldosterone blockers (OR: 1.3, p = 0.001) or angiotensin II receptor blockers (ARBs) (OR: 1.2, p = 0.035) Conclusions: The preexisting condition of hypertension had an independent prognostic value for all-cause mortality in patients with COVID-19 who required hospitalization. ARBs showed a lower risk of lethality in hypertensive patients than other antihypertensive drugs.