According to a draft report from the Institute for Clinical and Economic Review (ICER), the cost of currently available Covid-19 outpatient treatments, including monoclonal antibodies and antiviral pills, are "reasonably aligned" with their benefits for patients.
Report details and findings
For the report, ICER examined four Covid-19 treatments: GlaxoSmithKline (GSK) and Vir's monoclonal antibody sotrovimab, Pfizer's antiviral pill Paxlovid, Merck's antiviral pill molnupiravir, and the generic drug fluvoxamine. All analyzed treatments have been authorized for Covid-19 treatment by FDA except for fluvoxamine, although it can be prescribed off-label to treat the disease.
To estimate the cost-effectiveness of each treatment, ICER used four measures:
- Cost per quality-adjusted life year (QALY) gained
- Cost per life year gained
- Cost per equal-value life year gained
- Cost per in-person hospitalization averted
ICER considered all the treatments to be cost-effective since they cost under $100,000 per QALY. Sotrovimab, molnupiravir, Paxlovid, and fluvoxamine cost $2,100, $707, $529, and $12, respectively, per treatment.
When balancing these treatment costs and QALY, ICER found that fluvoxamine offered the best value for patients, followed by Paxlovid, molnupiravir, and sotrovimab. However, fluvoxamine reduced the relative risk of Covid-19-associated acute care when compared with placebo by only 32%, while sotrovimab, molnupiravir, and Paxlovid reduced the relative risk of hospitalization or death by 79%, 30%, and 88%, respectively.
"These treatments also have important potential benefits that cannot be fully captured or evaluated in the economic model, including the potential for preventing further spread of SARS-CoV-2 and improving hospital capacity," ICER wrote. "In addition, effective outpatient treatments may help provide psychological reassurance allowing for broader opening of schools and workplaces, and help address the disparate burden of the pandemic in disadvantaged communities."
According to Steve Pearson, ICER founder and president, the report's initial findings are unique since ICER typically finds that drugs are reasonably priced only around 25% of the time.
"The unique feature here is these prices are the product of price negotiation, at least for two of them [Paxlovid and molnupiravir]," Pearson said, noting that this may be the first time ICER has evaluated drugs whose prices were negotiated by the federal government.
However, Pearson added that ICER's analysis is still preliminary and could change if the risk of hospitalization from omicron or a future variant proves to be lower or if the treatments were used in lower-risk populations, which could significantly reduce their cost effectiveness.
Currently, ICER is accepting public comments on its draft report through March 3 and is expected to issue an updated report in late March, Reuters reports. (Brennan, Endpoints News, 2/3; Adams, Becker's Hospital Review, 2/4; Beasley, Reuters, 2/3)