Cost-Effectiveness of Antiviral Treatments for Pandemics and Outbreaks of Respiratory Illnesses, Including COVID-19: A Systematic Review of Published Economic Evaluations

• Published in: Value in health Vol. 23; no. 11; pp. 1409 - 1422
• Main Authors: Dawoud, Dalia M., Soliman, Khaled Y.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2020; Elsevier Science Ltd; ISPOR-The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc
• Subjects: Antiviral Agents - economics; Antiviral drugs; Betacoronavirus - drug effects; coronavirus; Coronavirus Infections - drug therapy; Coronavirus Infections - epidemiology; Coronaviruses; Cost analysis; Cost benefit analysis; COVID-19; Disease Outbreaks; economic evaluation; Health services; health technology assessment; Humans; Illnesses; influenza; Medical technology; Older people; outbreaks; Pandemics; Pneumonia, Viral - drug therapy; Pneumonia, Viral - epidemiology; Resource allocation; Respiratory diseases; Respiratory Insufficiency - drug therapy; Respiratory Insufficiency - epidemiology; Reviews; SARS-CoV-2; Systematic review; Technology assessment; Technology Assessment, Biomedical; Themed Section: COVID-19; Thresholds; Tracking; Utility functions; Willingness to pay; Young adults; influenza; COVID-19; health technology assessment; coronavirus; outbreaks; economic evaluation; systematic review; pandemics
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2020.07.002

To review published economic evaluations of antiviral treatment for pandemics and outbreaks of respiratory illnesses. We conducted a systematic review to identify economic evaluations of antiviral treatment for pandemics and outbreaks of respiratory illnesses, including coronavirus disease 2019 (COVID-19). We searched Medline (EBSCOhost), EMBASE (Ovid), EconLit (Ovid), National Health Service Economic Evaluation Database (Ovid), and Health Technology Assessment (Ovid). The search was last rerun on July 5, 2020. Citation tracking and reference checking were used. Only full economic evaluations published as peer-reviewed articles in the last 10 years were included. Studies were quality assessed using the National Institute for Health and Care Excellence economic evaluation checklist. Overall, 782 records were identified, of which 14 studies met the inclusion criteria. The studies were mostly conducted in high-income countries. All were model-based. Seven (50%) were cost-utility analyses, 4 (28.6%) were cost-effectiveness analyses, 2 (14.3%) were cost-consequences analyses, and 1 (7.1%) was a cost-benefit analysis. Strategies including antiviral treatment were found to be either cost-saving or cost-effective, at the study-specific willingness-to-pay thresholds. Empirical treatment was more cost-effective than test-guided treatment for young adults but less so for older adults. Antiviral treatment for managing pandemics and outbreaks of respiratory illnesses that have very high case fatality rate, similar to COVID-19 pandemic, are likely to be cost-effective either as a standalone intervention or part of a multifaceted strategy. Investing in the development of such curative treatments and promptly evaluating their cost-effectiveness, relative to other strategies in use at the time of their introduction should be the focus going forward to inform resource allocation decisions particularly in low- and middle-income countries. What is already known about this topic?•A number of mitigation strategies for pandemics and outbreaks of respiratory illnesses, similar to coronavirus disease 2019 (COVID-19), exist. These include both pharmaceutical and non-pharmaceutical strategies.•The potential cost-effectiveness of antiviral treatment is currently uncertain, and the factors affecting it are not fully understood. What does this article add to the body of knowledge?•This review confirms the potential cost-effectiveness of antiviral treatment as a mitigation strategy.•The review also identifies factors that affect the cost-effectiveness of these agents, including their relative effectiveness, cost, the severity of the pandemic, and its case fatality rate. What insights does the article provide for informing healthcare-related decision making?•This review provides a rationale for continued investment in the development of novel antivirals and other potentially curative treatments for COVID-19 in addition to the focus on vaccine development•There is a clear need for healthcare systems in low- and middle-income countries to undertake economic evaluations of antivirals and other mitigation strategies for pandemics and outbreaks of respiratory illnesses, given the lack of studies applicable to their settings, to inform the widespread use of such strategies.