Cost-effectiveness Analysis of Nirmatrelvir/Ritonavir Compared with Molnupiravir in Patients at High Risk for Progression to Severe COVID-19 in Japan.

IF 2.3 Q2 ECONOMICS Journal of Health Economics and Outcomes Research Pub Date : 2025-02-24 eCollection Date: 2025-01-01 DOI:10.36469/001c.129067

Akira Yuasa, Hiroyuki Matsuda, Yosuke Fujii, Tendai Mugwagwa, Yuki Kado, Mizuki Yoshida, Koichi Murata, Yoshiaki Gu

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Nirmatrelvir/ritonavir was compared with molnupiravir, and in the scenario analysis NMV/r was compared with standard of care over a lifetime horizon. Results: When compared with molnupiravir, NMV/r showed higher quality-adjusted life years (QALYs) (15.752 vs 15.739) and higher total cost (¥6 248 014 vs ¥6 245 829 [US <math><mn>44</mn> <mrow><mo> </mo></mrow> <mn>136.86</mn> <mi>v</mi> <mi>s</mi></math> 44 121.42]). The incremental cost-effectiveness ratio was ¥164 934 (US <math><mn>1165.12</mn> <mo>)</mo> <mi>p</mi> <mi>e</mi> <mi>r</mi> <mi>Q</mi> <mi>A</mi> <mi>L</mi> <mi>Y</mi> <mi>g</mi> <mi>a</mi> <mi>i</mi> <mi>n</mi> <mi>e</mi> <mi>d</mi> <mo>,</mo> <mi>w</mi> <mi>h</mi> <mi>i</mi> <mi>c</mi> <mi>h</mi> <mi>w</mi> <mi>a</mi> <mi>s</mi> <mi>l</mi> <mi>o</mi> <mi>w</mi> <mi>e</mi> <mi>r</mi> <mi>t</mi> <mi>h</mi> <mi>a</mi> <mi>n</mi> <mi>t</mi> <mi>h</mi> <mi>e</mi> <mi>w</mi> <mi>i</mi> <mi>l</mi> <mi>l</mi> <mi>i</mi> <mi>n</mi> <mi>g</mi> <mi>n</mi> <mi>e</mi> <mi>s</mi> <mi>s</mi> <mo>-</mo> <mi>t</mi> <mi>o</mi> <mo>-</mo> <mi>p</mi> <mi>a</mi> <mi>y</mi> <mo>(</mo> <mi>W</mi> <mi>T</mi> <mi>P</mi> <mo>)</mo> <mi>t</mi> <mi>h</mi> <mi>r</mi> <mi>e</mi> <mi>s</mi> <mi>h</mi> <mi>o</mi> <mi>l</mi> <mi>d</mi> <mi>i</mi> <mi>n</mi> <mi>J</mi> <mi>a</mi> <mi>p</mi> <mi>a</mi> <mi>n</mi> <mo>(</mo> <mrow><mo>¥</mo></mrow> <mn>5</mn> <mrow><mo> </mo></mrow> <mn>000</mn> <mrow><mo> </mo></mrow> <mn>000</mn> <mrow><mo>/</mo></mrow> <mi>Q</mi> <mi>A</mi> <mi>L</mi> <mi>Y</mi> <mo>[</mo> <mi>U</mi> <mi>S</mi></math> 35 320.71/QALY]). In the scenario analysis, the incremental cost-effectiveness ratio was ¥3 646 821 (US <math><mn>25</mn> <mrow><mo> </mo></mrow> <mn>761.66</mn> <mo>)</mo> <mi>p</mi> <mi>e</mi> <mi>r</mi> <mi>Q</mi> <mi>A</mi> <mi>L</mi> <mi>Y</mi> <mi>g</mi> <mi>a</mi> <mi>i</mi> <mi>n</mi> <mi>e</mi> <mi>d</mi> <mo>.</mo> <mi>O</mi> <mi>n</mi> <mi>e</mi> <mo>-</mo> <mi>w</mi> <mi>a</mi> <mi>y</mi> <mi>s</mi> <mi>e</mi> <mi>n</mi> <mi>s</mi> <mi>i</mi> <mi>t</mi> <mi>i</mi> <mi>v</mi> <mi>i</mi> <mi>t</mi> <mi>y</mi> <mi>a</mi> <mi>n</mi> <mi>a</mi> <mi>l</mi> <mi>y</mi> <mi>s</mi> <mi>i</mi> <mi>s</mi> <mi>a</mi> <mi>n</mi> <mi>d</mi> <mi>p</mi> <mi>r</mi> <mi>o</mi> <mi>b</mi> <mi>a</mi> <mi>b</mi> <mi>i</mi> <mi>l</mi> <mi>i</mi> <mi>s</mi> <mi>t</mi> <mi>i</mi> <mi>c</mi> <mi>s</mi> <mi>e</mi> <mi>n</mi> <mi>s</mi> <mi>i</mi> <mi>t</mi> <mi>i</mi> <mi>v</mi> <mi>i</mi> <mi>t</mi> <mi>y</mi> <mi>a</mi> <mi>n</mi> <mi>a</mi> <mi>l</mi> <mi>y</mi> <mi>s</mi> <mi>i</mi> <mi>s</mi> <mi>s</mi> <mi>h</mi> <mi>o</mi> <mi>w</mi> <mi>e</mi> <mi>d</mi> <mi>t</mi> <mi>h</mi> <mi>a</mi> <mi>t</mi> <mi>N</mi> <mi>M</mi> <mi>V</mi> <mrow><mo>/</mo></mrow> <mi>r</mi> <mi>w</mi> <mi>a</mi> <mi>s</mi> <mi>c</mi> <mi>o</mi> <mi>s</mi> <mi>t</mi> <mo>-</mo> <mi>e</mi> <mi>f</mi> <mi>f</mi> <mi>e</mi> <mi>c</mi> <mi>t</mi> <mi>i</mi> <mi>v</mi> <mi>e</mi> <mi>c</mi> <mi>o</mi> <mi>m</mi> <mi>p</mi> <mi>a</mi> <mi>r</mi> <mi>e</mi> <mi>d</mi> <mi>w</mi> <mi>i</mi> <mi>t</mi> <mi>h</mi> <mi>m</mi> <mi>o</mi> <mi>l</mi> <mi>n</mi> <mi>u</mi> <mi>p</mi> <mi>i</mi> <mi>r</mi> <mi>a</mi> <mi>v</mi> <mi>i</mi> <mi>r</mi> <mi>a</mi> <mi>n</mi> <mi>d</mi> <mi>s</mi> <mi>t</mi> <mi>a</mi> <mi>n</mi> <mi>d</mi> <mi>a</mi> <mi>r</mi> <mi>d</mi> <mi>o</mi> <mi>f</mi> <mi>c</mi> <mi>a</mi> <mi>r</mi> <mi>e</mi> <mi>c</mi> <mi>o</mi> <mi>n</mi> <mi>s</mi> <mi>i</mi> <mi>s</mi> <mi>t</mi> <mi>e</mi> <mi>n</mi> <mi>t</mi> <mi>l</mi> <mi>y</mi> <mo>.</mo> <mi>A</mi> <mi>l</mi> <mi>l</mi> <mi>r</mi> <mi>e</mi> <mi>s</mi> <mi>u</mi> <mi>l</mi> <mi>t</mi> <mi>s</mi> <mi>o</mi> <mi>f</mi> <mi>o</mi> <mi>n</mi> <mi>e</mi> <mo>-</mo> <mi>w</mi> <mi>a</mi> <mi>y</mi> <mi>s</mi> <mi>e</mi> <mi>n</mi> <mi>s</mi> <mi>i</mi> <mi>t</mi> <mi>i</mi> <mi>v</mi> <mi>i</mi> <mi>t</mi> <mi>y</mi> <mi>a</mi> <mi>n</mi> <mi>a</mi> <mi>l</mi> <mi>y</mi> <mi>s</mi> <mi>i</mi> <mi>s</mi> <mi>s</mi> <mi>h</mi> <mi>o</mi> <mi>w</mi> <mi>e</mi> <mi>d</mi> <mi>t</mi> <mi>h</mi> <mi>a</mi> <mi>t</mi> <mi>t</mi> <mi>h</mi> <mi>e</mi> <mi>i</mi> <mi>n</mi> <mi>c</mi> <mi>r</mi> <mi>e</mi> <mi>m</mi> <mi>e</mi> <mi>n</mi> <mi>t</mi> <mi>a</mi> <mi>l</mi> <mi>c</mi> <mi>o</mi> <mi>s</mi> <mi>t</mi> <mo>-</mo> <mi>e</mi> <mi>f</mi> <mi>f</mi> <mi>e</mi> <mi>c</mi> <mi>t</mi> <mi>i</mi> <mi>v</mi> <mi>e</mi> <mi>n</mi> <mi>e</mi> <mi>s</mi> <mi>s</mi> <mi>r</mi> <mi>a</mi> <mi>t</mi> <mi>i</mi> <mi>o</mi> <mi>s</mi> <mi>w</mi> <mi>e</mi> <mi>r</mi> <mi>e</mi> <mi>b</mi> <mi>e</mi> <mi>l</mi> <mi>o</mi> <mi>w</mi> <mi>t</mi> <mi>h</mi> <mi>e</mi> <mi>W</mi> <mi>T</mi> <mi>P</mi> <mi>t</mi> <mi>h</mi> <mi>r</mi> <mi>e</mi> <mi>s</mi> <mi>h</mi> <mi>o</mi> <mi>l</mi> <mi>d</mi> <mi>i</mi> <mi>n</mi> <mi>J</mi> <mi>a</mi> <mi>p</mi> <mi>a</mi> <mi>n</mi> <mo>.</mo> <mi>T</mi> <mi>h</mi> <mi>e</mi> <mi>r</mi> <mi>e</mi> <mi>s</mi> <mi>u</mi> <mi>l</mi> <mi>t</mi> <mi>o</mi> <mi>f</mi> <mi>t</mi> <mi>h</mi> <mi>e</mi> <mi>c</mi> <mi>o</mi> <mi>s</mi> <mi>t</mi> <mo>-</mo> <mi>e</mi> <mi>f</mi> <mi>f</mi> <mi>e</mi> <mi>c</mi> <mi>t</mi> <mi>i</mi> <mi>v</mi> <mi>e</mi> <mi>n</mi> <mi>e</mi> <mi>s</mi> <mi>s</mi> <mi>a</mi> <mi>c</mi> <mi>c</mi> <mi>e</mi> <mi>p</mi> <mi>t</mi> <mi>a</mi> <mi>b</mi> <mi>i</mi> <mi>l</mi> <mi>i</mi> <mi>t</mi> <mi>y</mi> <mi>c</mi> <mi>u</mi> <mi>r</mi> <mi>v</mi> <mi>e</mi> <mi>s</mi> <mi>h</mi> <mi>o</mi> <mi>w</mi> <mi>e</mi> <mi>d</mi> <mi>t</mi> <mi>h</mi> <mi>a</mi> <mi>t</mi> <mi>t</mi> <mi>h</mi> <mi>e</mi> <mi>p</mi> <mi>r</mi> <mi>o</mi> <mi>b</mi> <mi>a</mi> <mi>b</mi> <mi>i</mi> <mi>l</mi> <mi>i</mi> <mi>t</mi> <mi>y</mi> <mi>t</mi> <mi>h</mi> <mi>a</mi> <mi>t</mi> <mi>t</mi> <mi>h</mi> <mi>e</mi> <mi>i</mi> <mi>n</mi> <mi>c</mi> <mi>r</mi> <mi>e</mi> <mi>m</mi> <mi>e</mi> <mi>n</mi> <mi>t</mi> <mi>a</mi> <mi>l</mi> <mi>c</mi> <mi>o</mi> <mi>s</mi> <mi>t</mi> <mo>-</mo> <mi>e</mi> <mi>f</mi> <mi>f</mi> <mi>e</mi> <mi>c</mi> <mi>t</mi> <mi>i</mi> <mi>v</mi> <mi>e</mi> <mi>n</mi> <mi>e</mi> <mi>s</mi> <mi>s</mi> <mi>r</mi> <mi>a</mi> <mi>t</mi> <mi>i</mi> <mi>o</mi> <mi>w</mi> <mi>a</mi> <mi>s</mi> <mi>b</mi> <mi>e</mi> <mi>l</mi> <mi>o</mi> <mi>w</mi> <mi>t</mi> <mi>h</mi> <mi>e</mi> <mi>W</mi> <mi>T</mi> <mi>P</mi> <mi>o</mi> <mi>f</mi> <mrow><mo>¥</mo></mrow> <mn>5</mn> <mrow><mo> </mo></mrow> <mn>000</mn> <mrow><mo> </mo></mrow> <mn>000</mn> <mrow><mo>/</mo></mrow> <mi>Q</mi> <mi>A</mi> <mi>L</mi> <mi>Y</mi> <mo>(</mo> <mi>U</mi> <mi>S</mi></math> 35 320.71/QALY) was 100.00%. Conclusion: Nirmatrelvir/ritonavir is cost-effective compared with molnupiravir and standard of care from a Japanese payer perspective. This study provides evidence for the cost-effectiveness of NMV/r for patients with COVID-19.","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"12 1","pages":"75-85"},"PeriodicalIF":2.3000,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864595/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Health Economics and Outcomes Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.36469/001c.129067","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ECONOMICS","Score":null,"Total":0}

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Abstract

Background: Nirmatrelvir/ritonavir (NMV/r) and molnupiravir are oral antiviral drugs approved for the treatment of early symptomatic patients with mild to moderate COVID-19 at high risk of progression to severe disease in Japan. Objective: This study evaluated, from a Japanese payer perspective, the cost-effectiveness of NMV/r compared with molnupiravir among patients with COVID-19. Methods: This cost-effectiveness model describes the COVID-19 disease history and the impact of antiviral treatment on short-term and long-term outcomes. Nirmatrelvir/ritonavir was compared with molnupiravir, and in the scenario analysis NMV/r was compared with standard of care over a lifetime horizon. Results: When compared with molnupiravir, NMV/r showed higher quality-adjusted life years (QALYs) (15.752 vs 15.739) and higher total cost (¥6 248 014 vs ¥6 245 829 [US $44 136.86 v s$ 44 121.42]). The incremental cost-effectiveness ratio was ¥164 934 (US $1165.12) p e r Q A L Y g a i n e d, w h i c h w a s l o w e r t h a n t h e w i l l i n g n e s s - t o - p a y (W T P) t h r e s h o l d i n J a p a n (¥ 5 000 000 / Q A L Y [U S$ 35 320.71/QALY]). In the scenario analysis, the incremental cost-effectiveness ratio was ¥3 646 821 (US $25 761.66) p e r Q A L Y g a i n e d . O n e - w a y s e n s i t i v i t y a n a l y s i s a n d p r o b a b i l i s t i c s e n s i t i v i t y a n a l y s i s s h o w e d t h a t N M V / r w a s c o s t - e f f e c t i v e c o m p a r e d w i t h m o l n u p i r a v i r a n d s t a n d a r d o f c a r e c o n s i s t e n t l y . A l l r e s u l t s o f o n e - w a y s e n s i t i v i t y a n a l y s i s s h o w e d t h a t t h e i n c r e m e n t a l c o s t - e f f e c t i v e n e s s r a t i o s w e r e b e l o w t h e W T P t h r e s h o l d i n J a p a n . T h e r e s u l t o f t h e c o s t - e f f e c t i v e n e s s a c c e p t a b i l i t y c u r v e s h o w e d t h a t t h e p r o b a b i l i t y t h a t t h e i n c r e m e n t a l c o s t - e f f e c t i v e n e s s r a t i o w a s b e l o w t h e W T P o f ¥ 5 000 000 / Q A L Y (U S$ 35 320.71/QALY) was 100.00%. Conclusion: Nirmatrelvir/ritonavir is cost-effective compared with molnupiravir and standard of care from a Japanese payer perspective. This study provides evidence for the cost-effectiveness of NMV/r for patients with COVID-19.

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日本尼马特利韦/利托那韦与莫努匹拉韦在进展为严重COVID-19高风险患者中的成本-效果分析

背景：Nirmatrelvir/ritonavir （NMV/r）和molnupiravir是日本批准用于治疗轻至中度早期症状且进展为严重疾病高风险的COVID-19患者的口服抗病毒药物。目的：本研究从日本支付者的角度，评价NMV/r与莫诺匹拉韦在COVID-19患者中的成本-效果。方法：该成本-效果模型描述了COVID-19疾病史以及抗病毒治疗对短期和长期预后的影响。将Nirmatrelvir/ritonavir与molnupiravir进行比较，并在情景分析中将NMV/r与生命周期内的标准护理进行比较。结果：与莫诺匹拉韦相比，NMV/r具有更高的质量调整生命年（QALYs）（15.752 vs 15.739）和更高的总成本（6 248 014 vs 6 245 829 [US 44 136.86 vs s 44 121.42]）。增量成本效益比率¥164 934(合1165.12)p e r L Y g i n e d w h i w c h s L o w e r t h n t h e w我L L n g n e s s - t o - p Y (w t p) t h r e s h o L d i n J p n(¥5 000 000 / Q L Y [U s 35 320.71 / QALY])。在情景分析中，增量成本-效果比为3 646 821日元（25 761.66美元）/ Q / A / L / d / d。O n e - w y s e n s我t v t y一个l n y s i s n d p r O b b我l s t c s e n s我t v t y一个l n y s i s s h O w e t h t n M v d s c O s t / r w - e f f e c t i v e c O M p r e d w i t h M O l n u p ir i r n d s t n d r d O f c r e c O n s i s t e n t l y。l l r e s u l t s o f o n e - w y s e n s我t v t y一个l n y s i s s h o w e d t h t t h e n c r e m e n t l c o s e t - f f e c t i v e n e s s r t i o s w e r e b e l o w t h e w t P t h r e s h o P l d i n J n。T h e r e s u l T o f T h e c o s e T - f f e c T i v e n e s s c c e p T b我l T y c u r e s h o w e d T h T T h e p r o b b我l T y T h T T h e n c r e m e n T l c o s e T - f f e c T i v e n e s s r T i o w s b e l o w T h e p w T o f¥5 000 000 / Q l y (u s 35 320.71 / QALY)为100.00%。结论：从日本支付者的角度来看，与莫努匹拉韦和标准护理相比，尼马特利韦/利托那韦具有成本效益。本研究为NMV/r治疗COVID-19患者的成本效益提供了证据。

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