OBJECTIVES: Paxlovid (nirmatrelvir+ritonavir) is indicated for the treatment of COVID-19 in adults who do not require supplemental oxygen and are at increased risk of progression to severe disease. This study evaluates the cost-effectiveness of Paxlovid versus standard of care (SoC) in the treatment of COVID-19 in adults at high risk of severe disease from the perspective of the National Health Service in Portugal to support public funding decision-making.

METHODS: A cost-effectiveness model was comprised of a decision tree to estimate short-term costs and outcomes during the first year and complemented by a long-term Markov model simulating lifetime horizon with annual cycles consisting of two states (living and dead). As in EPIC-HR clinical trial, the economic comparator in this analysis was SoC. The model considers 1000 treatment eligible adults with model inputs sourced from peer-reviewed literature and local data including baseline event rates, direct medical costs related to the acquisition of the medicine, outpatient and inpatient health care utilization. Outcomes included number of hospitalizations, deaths, costs, quality-adjusted life years (QALYs), life-years (LY), and calculated incremental cost-effectiveness ratio (ICER). Costs and outcomes were discounted annually at 4% over a lifetime horizon. One-way and probabilistic sensitivity analyses were performed to test the model robustness.

RESULTS: When compared to SoC, Paxlovid treatment is associated with a reduction in hospitalizations (0.023 per infected case) and deaths (0.017 per infected case). These incremental changes were associated in a net cost of 902.72€ and 0.27 QALY gains over a lifetime horizon resulting in an ICER of 3,371€ per QALY. The model was most sensitive to the cost of Paxlovid treatment, effectiveness, and discount rate. Paxlovid remained cost-effective in the deterministic and probabilistic sensitivity analysis.

CONCLUSIONS: Our results suggests that Paxlovid is cost-effective compared to SoC for patients at high risk for severe COVID-19 from a health sector perspective in Portugal.