tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2022 Jan 19;9(3)
fac008.
doi: 10.1093/ofid/ofac008. eCollection 2022 Mar.
Outpatient Therapies for COVID-19: How Do We Choose?
Todd C Lee[SUP] 1 2 3 [/SUP], Andrew M Morris[SUP] 4 [/SUP], Steven A Grover[SUP] 3 5 [/SUP], Srinivas Murthy[SUP] 6 [/SUP], Emily G McDonald[SUP] 2 [/SUP]
Affiliations
Abstract
Background: Several outpatient coronavirus disease 2019 (COVID-19) therapies have reduced hospitalization in randomized controlled trials. The choice of therapy may depend on drug efficacy, toxicity, pricing, availability, and available infrastructure. To facilitate comparative decision-making, we evaluated the efficacy of each treatment in clinical trials and estimated the cost per hospitalization prevented.
Methods: Wherever possible, we obtained relative risk for hospitalization from published randomized controlled trials. Otherwise, we extracted data from press releases, conference abstracts, government submissions, or preprints. If there was >1 study, the results were meta-analyzed. Using relative risk, we estimated the number needed to treat (NNT), assuming a baseline hospitalization risk of 5%, and compared the cost per hospitalization prevented with the estimate for an average Medicare COVID-19 hospitalization ($21 752). Drug pricing was estimated from GoodRx, from government purchases, or manufacturer estimates. Administrative and societal costs were not included. Results will be updated online as new studies emerge and/or final numbers become available.
Results: At a 5% risk of hospitalization, the estimated NNT was 80 for fluvoxamine, 91 for colchicine, 72 for inhaled corticosteroids, 24 for nirmatrelvir/ritonavir, 50 for molnupiravir, 28 for remdesivir, 25 for sotrovimab, 29 for casirivimab/imdevimab, and 29 for bamlanivimab/etesevimab. For drug cost per hospitalization prevented, colchicine, fluvoxamine, inhaled corticosteroids, and nirmatrelvir/ritonavir were below the Medicare estimated hospitalization cost.
Conclusions: Many countries are fortunate to have access to several effective outpatient therapies to prevent COVID-19 hospitalization. Given differences in efficacy, toxicity, cost, and administration complexity, this assessment serves as one means to frame treatment selection.
Keywords: COVID-19; SARS-CoV-2; antivirals; monoclonal antibodies; repurposed medications.
. 2022 Jan 19;9(3)
fac008.doi: 10.1093/ofid/ofac008. eCollection 2022 Mar.
Outpatient Therapies for COVID-19: How Do We Choose?
Todd C Lee[SUP] 1 2 3 [/SUP], Andrew M Morris[SUP] 4 [/SUP], Steven A Grover[SUP] 3 5 [/SUP], Srinivas Murthy[SUP] 6 [/SUP], Emily G McDonald[SUP] 2 [/SUP]
Affiliations
- PMID: 35165657
- PMCID: PMC8807279
- DOI: 10.1093/ofid/ofac008
Abstract
Background: Several outpatient coronavirus disease 2019 (COVID-19) therapies have reduced hospitalization in randomized controlled trials. The choice of therapy may depend on drug efficacy, toxicity, pricing, availability, and available infrastructure. To facilitate comparative decision-making, we evaluated the efficacy of each treatment in clinical trials and estimated the cost per hospitalization prevented.
Methods: Wherever possible, we obtained relative risk for hospitalization from published randomized controlled trials. Otherwise, we extracted data from press releases, conference abstracts, government submissions, or preprints. If there was >1 study, the results were meta-analyzed. Using relative risk, we estimated the number needed to treat (NNT), assuming a baseline hospitalization risk of 5%, and compared the cost per hospitalization prevented with the estimate for an average Medicare COVID-19 hospitalization ($21 752). Drug pricing was estimated from GoodRx, from government purchases, or manufacturer estimates. Administrative and societal costs were not included. Results will be updated online as new studies emerge and/or final numbers become available.
Results: At a 5% risk of hospitalization, the estimated NNT was 80 for fluvoxamine, 91 for colchicine, 72 for inhaled corticosteroids, 24 for nirmatrelvir/ritonavir, 50 for molnupiravir, 28 for remdesivir, 25 for sotrovimab, 29 for casirivimab/imdevimab, and 29 for bamlanivimab/etesevimab. For drug cost per hospitalization prevented, colchicine, fluvoxamine, inhaled corticosteroids, and nirmatrelvir/ritonavir were below the Medicare estimated hospitalization cost.
Conclusions: Many countries are fortunate to have access to several effective outpatient therapies to prevent COVID-19 hospitalization. Given differences in efficacy, toxicity, cost, and administration complexity, this assessment serves as one means to frame treatment selection.
Keywords: COVID-19; SARS-CoV-2; antivirals; monoclonal antibodies; repurposed medications.