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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.
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Objective: This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. Material and methods: This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. Results: Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1,128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. Conclusions: Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.
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OBJECTIVE: This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. MATERIAL AND METHODS: This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. RESULTS: Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. CONCLUSIONS: Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.