ABSTRACT
Introduction: Trials of remdesivir (RDV) for COVID-19 have provided evidence for regulatory approval. This is the first meta-analysis (MA) to evaluate the real-world effectiveness of RDV in patients hospitalized with COVID-19. Objective(s): To synthesize RDV observational data. Method(s): A systematic literature review identified observational studies of RDV. Outcomes were all-cause mortality and progression to invasive mechanical ventilation (IMV) assessed at early (day 14/15) and late (day 28/29/30) timepoints. MAs were conducted using standard random effects models;analyses were performed with R statistical software. Result(s): Of 1,069 studies identified, 29 met inclusion criteria for mortality data, 18 were excluded for low quality based on the ROBINS-I tool;11 studies from the United Kingdom, European Union, United States and Japan were included in the MA (N=166,399 patients). RDV was associated with a significant improvement in mortality at early (5 studies;risk ratio [RR] 0.71, 95% confidence interval [CI] 0.64-0.79) and late (10 studies, RR 0.82, 95%CI 0.71-0.95;Figure) timepoints. No significant effect was shown on the proportion of patients requiring IMV (evaluable only in the 3 studies denoted by asterisk in Figure, RR 1.07, 95%CI 0.84-1.34). Results were robust to scenario analyses. Conclusion(s): In a real-world setting, RDV is effective in reducing mortality in hospitalized COVID-19 patients.
ABSTRACT
Objectives: In the ACC2 - -1 study in hospitalized adults with laboratory confirmed COVID-19, remdesivir was found to be superior to placebo in shortening time to recovery from COVID-19. However, the economic value and health system impact of remdesivir treatment is still unclear. This study evaluated remdesivir’s long-term cost-effectiveness and impact on health system capacities versus standard of care (SoC) for hospitalized COVID-19 patients in the United States (US). Methods: A hybrid decision-tree and Markov model simulated health and economic outcomes for hospitalized adult COVID-19 patients (average age of 58.9 years) from a US health system perspective over a lifetime horizon. Clinical inputs (e.g., hospitalization duration, mortality) were extracted from the ACC2 - -1 trial and real-world data. Cost inputs were sourced from an internal analysis or from the literature. Remdesivir acquisition cost was $390/vial, and patients were assumed to receive 6.25 vials per treatment course. One-way and probabilistic sensitivity analyses were performed. A separate treatment capacity analysis was performed on a national scale, assuming a population of 328,200,000 and one monthly incident cohort of 201,000 patients eligible for treatment. Results: Relative to SoC, remdesivir was associated with a decrease in total costs (savings of $8,844.49 per patient), increased life years (+0.62), and quality-adjusted life years (+0.47). Remdesivir was therefore dominant versus SoC (less costly and more effective). Results were robust in one-way and probabilistic sensitivity analyses. In the treatment capacity analysis, remdesivir increased the available hospital capacity by 1.4%, available ICU capacity by 32.1%, and total ventilator capacity by 2.3%. Conclusions: Remdesivir is a cost-effective option for the treatment of patients hospitalized with mild, moderate, and severe COVID-19 versus SoC. In addition, due to its demonstrated ability to shorten time to recovery, remdesivir is projected to increase treatment capacity by increasing the percentage of available hospital bed-, ICU bed-, and total ventilator capacity.