OBJECTIVES: Nirmatrelvir/ritonavir (NMV/r) is an antiviral agent recommended for adults at increased risk for progression to severe COVID-19, regardless of vaccination status, and is reimbursed in Sweden according to label. Both the pivotal study EPIC-HR and real-world evidence (RWE) have shown that the agent is effective in preventing hospitalization and death. This study assessed the cost-effectiveness of NMV/r for 54 risk groups, stratified by age, comorbidity, and vaccination status, compared to standard-of-care (SoC) in Sweden.

METHODS: A closed-cohort, static cost-effectiveness model was developed using a decision tree for the first year, and a Markov model for the life-time horizon. The model accounted for symptom days, hospitalizations, intensive care unit admissions, quality of life, mortality, and treatment costs. It had a conservative approach by excluding the considerable, but still uncertain, costs related to post-acute covid syndrome. The baseline absolute risks of hospitalization and death were collected from published data for 54 risk groups. The relative risk-reduction was set to 79.6%, based on RWE to reflect omicron vaccinated era. Quality-adjusted life years and costs were accumulated over the patients’ life expectancy and the incremental cost-effectiveness ratio (ICER) was calculated.

RESULTS: NMV/r was a dominant treatment option in 12 risk groups. Utilizing a willingness to pay threshold of SEK 500.000 resulted in NMV/R being cost-effective in 30 risk groups. NMV/r was cost-effective in all patient groups older than 50 years with high comorbidity status. Only among patients younger than 40 years there were no risk groups in which NMV/r was cost-effective. NMV/r was cost-effective for all patients older than 70 years, except for those with no comorbidities that had been vaccinated in the prior 180 days.

CONCLUSIONS: This study suggests that utilization of nirmatrelvir/ritonavir is cost-effective compared to SoC for most patient groups, and especially for patients older than 70 years.