Cost-utility analysis of molnupiravir for high-risk, community-based adults with COVID-19: an economic evaluation of the PANORAMIC trial

• Published in: British journal of general practice Vol. 74; no. 745; pp. e570 - e579
• Main Authors: Png, May Ee, Harris, Victoria, Grabey, Jenna, Hart, Nigel D, Jani, Bhautesh D, Butler, Daniel, Carson-Stevens, Andrew, Coates, Maria, Cureton, Lucy, Dobson, Melissa, Dorward, Jienchi, Evans, Philip, Francis, Nick, Gbinigie, Oghenekome A, Hayward, Gail, Holmes, Jane, Hood, Kerenza, Khoo, Saye, Ahmed, Haroon, Lown, Mark, McKenna, Micheal, Mort, Sam, Nguyen-Van-Tam, Jonathan S, Rahman, Najib M, Richards, Duncan B, Thomas, Nicholas Pb, van Hecke, Oliver, Hobbs, Richard, Little, Paul, Yu, Ly-Mee, Butler, Christopher C, Petrou, Stavros
• Format: Journal Article
• Language: English
• Published: England Royal College of General Practitioners 01.08.2024
• Subjects: Adult; Antiviral Agents - economics; Antiviral Agents - therapeutic use; Antiviral drugs; Cost analysis; Cost-Benefit Analysis; COVID-19 - economics; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID-19 Drug Treatment; Cytidine - analogs & derivatives; Cytidine - economics; Cytidine - therapeutic use; Female; Humans; Hydroxylamines - economics; Hydroxylamines - therapeutic use; Male; Middle Aged; Oral administration; Quality-Adjusted Life Years; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; United Kingdom; United Kingdom; United Kingdom > UK; COVID-19; quality-adjusted life years; antiviral drugs; SARS-CoV-2; molnupiravir; cost-benefit analysis
• ISSN: 0960-1643; 1478-5242; 1478-5242
• DOI: 10.3399/BJGP.2023.0444

The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations. To evaluate the cost-effectiveness of molnupiravir relative to usual care alone among mainly vaccinated community-based people at higher risk of severe outcomes from COVID-19 over 6 months. An economic evaluation of the PANORAMIC trial in the UK. A cost-utility analysis that adopted a UK NHS and personal social services perspective and a 6-month time horizon was performed using PANORAMIC trial data. Cost-effectiveness was expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity and subgroup analyses assessed the impacts of uncertainty and heterogeneity. Threshold analysis explored the price for molnupiravir consistent with likely reimbursement. In the base-case analysis, molnupiravir had higher mean costs of £449 (95% confidence interval [CI] = 445 to 453) and higher mean QALYs of 0.0055 (95% CI = 0.0044 to 0.0067) than usual care (mean incremental cost per QALY of £81 190). Sensitivity and subgroup analyses showed similar results, except for those aged ≥75 years, with a 55% probability of being cost-effective at a £30 000 per QALY threshold. Molnupiravir would have to be priced around £147 per course to be cost-effective at a £15 000 per QALY threshold. At the current cost of £513 per course, molnupiravir is unlikely to be cost-effective relative to usual care over a 6-month time horizon among mainly vaccinated patients with COVID-19 at increased risk of adverse outcomes, except those aged ≥75 years.