OBJECTIVES: In May 2023, nirmatrelvir/ritonavir (NMV/r) was FDA approved for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who are at high risk for progression to severe COVID-19. After HHS announced a transition of NMV/r to the commercial market in November 2023, a budget impact model (BIM) is needed to help decision-makers understand the clinical and economic impact of providing access to NMV/r.

METHODS: A BIM was developed to assess the impact of NMV/r on healthcare costs in a hypothetical 1-million-member health plan over a 1-year period in the US. Population, clinical, and cost inputs were derived from published literature, focusing on the recent COVID-19 era of vaccinated patients and predominance of the Omicron variant. Treatment impact on hospitalization, death and health care resource utilization was considered in the base case. Treatment effects on post-COVID conditions (PCC) was assessed in a scenario analysis. Outcomes included the number of hospitalizations, total cost, per-member per-month (PMPM) costs, and annual cost per treated patient (PPPY). Sensitivity and scenario analyses were conducted to assess uncertainty around model inputs.

RESULTS: An estimated 29,999 patients were eligible for treatment with NMV/r over one year. NMV/r use was estimated to reduce the number of hospitalizations by 631 with a budget impact of $1,302,304, $0.11 PMPM and $43 PPPY. NMV/r was cost savings when including PCCs with a budget impact of ‑$2,345,609, ‑$0.20 PMPM and ‑$78 PPPY. Sensitivity analyses indicated results were most sensitive to the price of NMV/r, risk of hospitalization under supportive care, and risk of hospitalization with NMV/r treatment.

CONCLUSIONS: Treatment with NMV/r in the current COVID-19 era is estimated to result in substantial cost offsets due to reductions in hospitalization and modest budget impact to potential overall cost savings for US health plans.