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Cost-Effectiveness of Baricitinib Compared With Standard of Care: A Modeling Study in Hospitalized Patients With COVID-19 in the United States.
Ohsfeldt, Robert; Kelton, Kari; Klein, Tim; Belger, Mark; Mc Collam, Patrick L; Spiro, Theodore; Burge, Russel; Ahuja, Neera.
  • Ohsfeldt R; Texas A&M University, College Station, Texas; Medical Decision Modeling Inc, Indianapolis, Indiana.
  • Kelton K; Medical Decision Modeling Inc, Indianapolis, Indiana.
  • Klein T; Medical Decision Modeling Inc, Indianapolis, Indiana.
  • Belger M; Eli Lilly and Company, Indianapolis, Indiana.
  • Mc Collam PL; Eli Lilly and Company, Indianapolis, Indiana.
  • Spiro T; Eli Lilly and Company, Indianapolis, Indiana.
  • Burge R; Eli Lilly and Company, Indianapolis, Indiana; University of Cincinnati, Cincinnati, Ohio. Electronic address: rburge@lilly.com.
  • Ahuja N; Stanford University, Palo Alto, California.
Clin Ther ; 43(11): 1877-1893.e4, 2021 11.
Article in English | MEDLINE | ID: covidwho-1506541
ABSTRACT

PURPOSE:

In the Phase III COV-BARRIER (Efficacy and Safety of Baricitinib for the Treatment of Hospitalised Adults With COVID-19) trial, treatment with baricitinib, an oral selective Janus kinase 1/2 inhibitor, in addition to standard of care (SOC), was associated with significantly reduced mortality over 28 days in hospitalized patients with coronavirus disease-2019 (COVID-19), with a safety profile similar to that of SOC alone. This study assessed the cost-effectiveness of baricitinib + SOC versus SOC alone (which included systemic corticosteroids and remdesivir) in hospitalized patients with COVID-19 in the United States.

METHODS:

An economic model was developed to simulate inpatients' stay, discharge to postacute care, and recovery. Costs modeled included payor costs, hospital costs, and indirect costs. Benefits modeled included life-years (LYs) gained, quality-adjusted life-years (QALYs) gained, deaths avoided, and use of mechanical ventilation avoided. The primary analysis was performed from a payor perspective over a lifetime horizon; a secondary analysis was performed from a hospital perspective. The base-case analysis modeled the numeric differences in treatment effectiveness observed in the COV-BARRIER trial. Scenario analyses were also performed in which the clinical benefit of baricitinib was limited to the statistically significant reduction in mortality demonstrated in the trial.

FINDINGS:

In the base-case payor perspective model, an incremental total cost of 17,276 US dollars (USD), total QALYs gained of 0.6703, and total LYs gained of 0.837 were found with baricitinib + SOC compared with SOC alone. With the addition of baricitinib, survival was increased by 5.1% and the use of mechanical ventilation was reduced by 1.6%. The base-case incremental cost-effectiveness ratios were 25,774 USD/QALY gained and 20,638 USD/LY gained; a "mortality-only" scenario analysis yielded similar results of 26,862 USD/QALY gained and 21,433 USD/LY gained. From the hospital perspective, combination treatment with baricitinib + SOC was more effective and less costly than was SOC alone in the base case, with an incremental cost of 38,964 USD per death avoided in the mortality-only scenario. IMPLICATIONS In hospitalized patients with COVID-19 in the United States, the addition of baricitinib to SOC was cost-effective. Cost-effectiveness was demonstrated from both the payor and the hospital perspectives. These findings were robust to sensitivity analysis and to conservative assumptions limiting the clinical benefits of baricitinib to the statistically significant reduction in mortality demonstrated in the COV-BARRIER trial.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Drug Treatment Type of study: Experimental Studies / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Humans Country/Region as subject: North America Language: English Journal: Clin Ther Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Drug Treatment Type of study: Experimental Studies / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Humans Country/Region as subject: North America Language: English Journal: Clin Ther Year: 2021 Document Type: Article