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Cost-effectiveness of casirivimab/imdevimab in patients with COVID-19 in the ambulatory setting.
Jovanoski, Nick; Kuznik, Andreas; Becker, Ursula; Hussein, Mohamed; Briggs, Andrew.
  • Jovanoski N; F Hoffman-La Roche Ltd, Basel, Switzerland.
  • Kuznik A; Regeneron Pharmaceuticals, Inc., Tarrytown, NY.
  • Becker U; F Hoffman-La Roche Ltd, Basel, Switzerland.
  • Hussein M; Regeneron Pharmaceuticals, Inc., Tarrytown, NY.
  • Briggs A; London School of Hygiene & Tropical Medicine, London, UK.
J Manag Care Spec Pharm ; 28(5): 555-565, 2022 May.
Article in English | MEDLINE | ID: covidwho-2145820
ABSTRACT

BACKGROUND:

Most patients infected with SARS-CoV-2, resulting in COVID-19, have only mild symptoms that can be managed in an ambulatory setting. However, a significant number of patients develop a more severe form of the disease and require hospital care, with the risk of long-term sequelae or death. Casirivimab/imdevimab is a combination of 2 recombinant human monoclonal antibodies that has been shown to significantly reduce the risk of hospitalization or death in patients with mild to moderate COVID-19 in the ambulatory setting.

OBJECTIVE:

To establish the cost-effectiveness of casirivimab/imdevimab in ambulatory individuals with COVID-19.

METHODS:

A cost-effectiveness model was constructed to simulate the natural history of COVID-19 in ambulatory patients and to identify those patients for whom casirivimab/imdevimab may be a cost-effective treatment from a US payer perspective. Patients enter the model in the ambulatory health state and can receive either active treatment with casirivimab/imdevimab or usual care. Patients can either recover from the infection or be hospitalized, from where they can recover from infection or die. Following this acute phase, patients enter a Markov model to estimate lifetime quality-adjusted life years. The model uses the risk of hospitalization in both the active treatment and usual care cohorts, and age- and sex-specific risk of mortality. Other model inputs include hospitalization costs and health-related utilities in the ambulatory acute treatment phase, the hospitalized setting, and the post-acute phase. Accounting for the heterogeneity of risk by age and comorbidities, results are presented separately for various combinations of baseline age and usual care risk in a 7 × 9 matrix. Outcomes related to "long COVID" are assessed in scenario analyses.

RESULTS:

In the base case, at a willingness-to-pay threshold of $100,000, treatment with casirivimab/imdevimab was found to be cost-effective in most patients, including those older than 40 years of age with a baseline hospitalization risk greater than or equal to 2% and patients aged 20 years with a baseline risk of hospitalization greater than or equal to 4%, whereas for hospitalization risk greater than or equal to 10%, casirivimab/imdevimab is dominant. Casirivimab/imdevimab was not cost-effective in patients aged 20 years with a 3% or lower risk of hospitalization or in patients aged 30 years with a 2% risk.

CONCLUSIONS:

This economic analysis found that casirivimab/imdevimab is a cost-effective treatment for most ambulatory patients with COVID-19. DISCLOSURES N. Jovanoski and U. Becker are employees of F Hoffman-La Roche Ltd.; A. Kuznik and M. Hussein are employees of Regeneron Pharmaceuticals Inc. and hold stock and stock options; A. Briggs has provided consultancy to F Hoffman-La Roche Ltd. and has received consultancy fees from Merck and Co., Inc., GlaxoSmithKline plc., and Novartis. This study was funded by Regeneron Pharmaceuticals, Inc.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Drug Treatment Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Female / Humans / Male Language: English Journal: J Manag Care Spec Pharm Year: 2022 Document Type: Article Affiliation country: JMCP.2022.21469

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Drug Treatment Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Female / Humans / Male Language: English Journal: J Manag Care Spec Pharm Year: 2022 Document Type: Article Affiliation country: JMCP.2022.21469