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1.
PLoS One ; 17(1): e0262462, 2022.
Article in English | MEDLINE | ID: covidwho-1630364

ABSTRACT

Remdesivir and dexamethasone are the only drugs providing reductions in the lengths of hospital stays for COVID-19 patients. We assessed the impacts of remdesivir on hospital-bed resources and budgets affected by the COVID-19 outbreak. A stochastic agent-based model was combined with epidemiological data available on the COVID-19 outbreak in France and data from two randomized control trials. Strategies involving treating with remdesivir only patients with low-flow oxygen and patients with low-flow and high-flow oxygen were examined. Treating all eligible low-flow oxygen patients during the entirety of the second wave would have decreased hospital-bed occupancy in conventional wards by 4% [2%; 7%] and intensive care unit (ICU)-bed occupancy by 9% [6%; 13%]. Extending remdesivir use to high-flow-oxygen patients would have amplified reductions in ICU-bed occupancy by up to 14% [18%; 11%]. A minimum remdesivir uptake of 20% was required to observe decreases in bed occupancy. Dexamethasone had effects of similar amplitude. Depending on the treatment strategy, using remdesivir would, in most cases, generate savings (up to 722€) or at least be cost neutral (an extra cost of 34€). Treating eligible patients could significantly limit the saturation of hospital capacities, particularly in ICUs. The generated savings would exceed the costs of medications.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/economics , Bed Occupancy/economics , Dexamethasone/economics , Adenosine Monophosphate/economics , Adenosine Monophosphate/therapeutic use , Alanine/economics , Alanine/therapeutic use , Antiviral Agents/therapeutic use , Bed Occupancy/statistics & numerical data , COVID-19/drug therapy , COVID-19/economics , COVID-19/virology , Dexamethasone/therapeutic use , France , Hospitalization/economics , Hospitalization/statistics & numerical data , Humans , Intensive Care Units , Length of Stay , Models, Statistical , SARS-CoV-2/isolation & purification
2.
Sci Rep ; 11(1): 17787, 2021 09 07.
Article in English | MEDLINE | ID: covidwho-1397899

ABSTRACT

Despite COVID-19's significant morbidity and mortality, considering cost-effectiveness of pharmacologic treatment strategies for hospitalized patients remains critical to support healthcare resource decisions within budgetary constraints. As such, we calculated the cost-effectiveness of using remdesivir and dexamethasone for moderate to severe COVID-19 respiratory infections using the United States health care system as a representative model. A 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 only moderate and only severe 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. Supportive care for moderate/severe COVID-19 cost $11,112.98 with 0.7155 quality adjusted life-year (QALY) obtained. Using dexamethasone for all patients was the most-cost effective with an incremental cost-effectiveness ratio of $980.84/QALY; all remdesivir strategies were more costly and less effective. Probabilistic sensitivity analyses showed dexamethasone for all patients was most cost-effective in 98.3% of scenarios. Dexamethasone for moderate-severe COVID-19 infections was the most cost-effective strategy and would have minimal budget impact. Based on current data, remdesivir is unlikely to be a cost-effective treatment for COVID-19.


Subject(s)
COVID-19/drug therapy , COVID-19/therapy , Health Care Costs/statistics & numerical data , Health Care Rationing/economics , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/economics , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/economics , Alanine/therapeutic use , COVID-19/diagnosis , COVID-19/economics , COVID-19/mortality , COVID-19/virology , Clinical Decision-Making/methods , Computer Simulation , Cost-Benefit Analysis , Dexamethasone/economics , Dexamethasone/therapeutic use , Health Care Rationing/organization & administration , Humans , Intensive Care Units/economics , Intensive Care Units/statistics & numerical data , Middle Aged , Oxygen/administration & dosage , Oxygen/economics , Quality-Adjusted Life Years , Respiration, Artificial/economics , SARS-CoV-2 , Severity of Illness Index , Treatment Outcome , United States/epidemiology
5.
Br J Clin Pharmacol ; 87(11): 4386-4396, 2021 11.
Article in English | MEDLINE | ID: covidwho-1186137

ABSTRACT

AIMS: The present study aimed to evaluate the cost-effectiveness of the 5-day remdesivir regimen compared with standard of care among severe COVID-19 patients in China, the evidence on which is essential to inform the necessity of securing access to remdesivir. METHODS: A dynamic transmission model that extended the susceptible-exposed-infected-recovered framework by incorporating asymptomatic, presymptomatic and waiting-to-be-diagnosed patients was constructed to conduct the cost-effectiveness analysis from the healthcare system perspective. To estimate epidemic parameters, the model was first calibrated to the observed epidemic curve in Wuhan from 23 January to 19 March 2020. Following the calibration, the infected compartment was replaced by 3 severity-defined health states to reflect differential costs and quality of life associated with disease gravity. Costs and quality-adjusted life year (QALY) outcomes of 9 million simulated people were accrued across time to evaluate the incremental cost-effectiveness ratio of remdesivir. As robustness checks, an alternative modelling technique using decision tree, additional epidemic scenarios representing different epidemic intensities, and 1-way parameter variations were also analysed. RESULTS: Remdesivir treatment cost CN¥97.93 million more than standard of care. Also, the net QALY gain from 5-day remdesivir treatment was 6947 QALYs. As such, the incremental cost-effectiveness ratio was CN¥14 098/QALY, substantially lower than the gross domestic product per capita threshold. The peak daily number of severe cases was 19% lower in the remdesivir treatment strategy. Overall, results were robust in alternative scenarios and sensitivity analyses. CONCLUSION: Given the cost-effectiveness profile, access to remdesivir for severe COVID-19 patients in China should be considered.


Subject(s)
Adenosine Monophosphate , Alanine , Antiviral Agents/therapeutic use , COVID-19 , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/economics , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/economics , Alanine/therapeutic use , Antiviral Agents/economics , COVID-19/drug therapy , COVID-19/economics , China , Cost-Benefit Analysis , Humans , Quality of Life
6.
Recenti Prog Med ; 112(3): 173-181, 2021 03.
Article in Italian | MEDLINE | ID: covidwho-1123706

ABSTRACT

When a pandemic occurs, scientific research moves fast in order to achieve readily results, such as effective therapies to fight the SARS-CoV-2 and vaccines. But this high-speed science, engaged by the emergency and characterized by the explosion of online publications in preprint form not subject to scrutiny by peer reviewers, carries some risks. And it represents a challenge to maintain research integrity and to comply with those globally recognized standard principles of fairness. Competition and the pressure to publish immediately - a way of encouraging rapid data sharing - can favor the dissemination of incomplete if not erroneous results obtained from partial studies, which feed false news, such as the benefits of a drug, and illusory hopes. It is commonly through press releases that "speed science" disseminates information to an audience that wants to be informed and reassured. Financial and political interests often mix with the urgency to find solutions. Covid-19 has highlighted in particular the risk of a politicization of science at the expense of transparency.


Subject(s)
COVID-19 , Pandemics , Publishing/standards , Research/standards , SARS-CoV-2 , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/economics , Adenosine Monophosphate/supply & distribution , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/economics , Alanine/supply & distribution , Alanine/therapeutic use , Antiviral Agents/economics , Antiviral Agents/supply & distribution , Antiviral Agents/therapeutic use , COVID-19 Vaccines/adverse effects , Disease Outbreaks , Drug Approval , European Union , Humans , Influenza, Human/drug therapy , Influenza, Human/economics , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Information Dissemination , Informed Consent , Oseltamivir/economics , Oseltamivir/supply & distribution , Oseltamivir/therapeutic use , Peer Review, Research , Periodicals as Topic , Politics , Risk , Time Factors , United States
8.
Pharmazie ; 75(8): 407-410, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-696997

ABSTRACT

New drugs against the in COVID-19 pandemic are urgently needed. Gilead Science's remdesivir has been introduced to China through special approval procedures, and was directly conducting the Phase III clinical trial. As expected, the marketing authorization process was completed soon. The drug brought hope to patients as well as business opportunities to companies. However, we must pay attention to the patent competition, generic drug competition and other unfair competition that remdesivir may face in China. China also needs to strengthen the innovation ability and international cooperation ability of local pharmaceutical companies by taking advantages of the opportunity to introduce remdesivir.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/administration & dosage , Coronavirus Infections/drug therapy , Pneumonia, Viral/drug therapy , Adenosine Monophosphate/administration & dosage , Adenosine Monophosphate/economics , Alanine/administration & dosage , Alanine/economics , Antiviral Agents/economics , COVID-19 , China , Clinical Trials as Topic , Coronavirus Infections/epidemiology , Drug Approval , Drug Industry/economics , Drugs, Generic/administration & dosage , Drugs, Generic/economics , Economic Competition , Humans , Pandemics , Pneumonia, Viral/epidemiology
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