RESUMEN
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.
RESUMEN
BACKGROUND: The impact of COVID-19 on the diagnosis and management of tuberculosis (TB) patients is unknown. METHODS: Participating centres completed a structured web-based survey regarding changes to TB patient management during the COVID-19 pandemic. The study also included data from participating centres on patients aged ≥18 diagnosed with TB in 2 periods: March 15 to June 30, 2020 and March 15 to June 30, 2019. Clinical variables and information about patient household contacts were retrospectively collected. RESULTS: A total of 7 (70%) TB units reported changes in their usual TB team operations. Across both periods of study, 169 patients were diagnosed with active TB (90 in 2019, 79 in 2020). Patients diagnosed in 2020 showed more frequent bilateral lesions in chest X-ray than patients diagnosed in 2019 (P = 0.004). There was a higher percentage of latent TB infection and active TB among children in households of patients diagnosed in 2020, compared with 2019 (P = 0.001). CONCLUSIONS: The COVID-19 pandemic has caused substantial changes in TB care. TB patients diagnosed during the COVID-19 pandemic showed more extended pulmonary forms. The increase in latent TB infection and active TB in children of patient households could reflect increased household transmission due to anti-COVID-19 measures.