Cost-effectiveness of Remdesivir and Dexamethasone for COVID-19 Treatment in South Africa.
COVID-19
SARS-CoV-2
cost-effectiveness
dexamethasone
hospital bed capacity
intensive care
mathematical model
remdesivir
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
18
11
2020
accepted:
24
01
2021
entrez:
18
3
2021
pubmed:
19
3
2021
medline:
19
3
2021
Statut:
epublish
Résumé
Dexamethasone and remdesivir have the potential to reduce coronavirus disease 2019 (COVID)-related mortality or recovery time, but their cost-effectiveness in countries with limited intensive care resources is unknown. We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed the cost-effectiveness of (1) administration of dexamethasone to ventilated patients and remdesivir to nonventilated patients, (2) dexamethasone alone to both nonventilated and ventilated patients, (3) remdesivir to nonventilated patients only, and (4) dexamethasone to ventilated patients only, all relative to a scenario of standard care. We estimated costs from the health care system perspective in 2020 US dollars, deaths averted, and the incremental cost-effectiveness ratios of each scenario. Remdesivir for nonventilated patients and dexamethasone for ventilated patients was estimated to result in 408 (uncertainty range, 229-1891) deaths averted (assuming no efficacy [uncertainty range, 0%-70%] of remdesivir) compared with standard care and to save $15 million. This result was driven by the efficacy of dexamethasone and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone for nonventilated and ventilated patients requires an additional $159 000 and averts 689 [uncertainty range, 330-1118] deaths, resulting in $231 per death averted, relative to standard care. The use of remdesivir for nonventilated patients and dexamethasone for ventilated patients is likely to be cost-saving compared with standard care by reducing ICU days. Further efforts to improve recovery time with remdesivir and dexamethasone in ICUs could save lives and costs in South Africa.
Sections du résumé
BACKGROUND
BACKGROUND
Dexamethasone and remdesivir have the potential to reduce coronavirus disease 2019 (COVID)-related mortality or recovery time, but their cost-effectiveness in countries with limited intensive care resources is unknown.
METHODS
METHODS
We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed the cost-effectiveness of (1) administration of dexamethasone to ventilated patients and remdesivir to nonventilated patients, (2) dexamethasone alone to both nonventilated and ventilated patients, (3) remdesivir to nonventilated patients only, and (4) dexamethasone to ventilated patients only, all relative to a scenario of standard care. We estimated costs from the health care system perspective in 2020 US dollars, deaths averted, and the incremental cost-effectiveness ratios of each scenario.
RESULTS
RESULTS
Remdesivir for nonventilated patients and dexamethasone for ventilated patients was estimated to result in 408 (uncertainty range, 229-1891) deaths averted (assuming no efficacy [uncertainty range, 0%-70%] of remdesivir) compared with standard care and to save $15 million. This result was driven by the efficacy of dexamethasone and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone for nonventilated and ventilated patients requires an additional $159 000 and averts 689 [uncertainty range, 330-1118] deaths, resulting in $231 per death averted, relative to standard care.
CONCLUSIONS
CONCLUSIONS
The use of remdesivir for nonventilated patients and dexamethasone for ventilated patients is likely to be cost-saving compared with standard care by reducing ICU days. Further efforts to improve recovery time with remdesivir and dexamethasone in ICUs could save lives and costs in South Africa.
Identifiants
pubmed: 33732750
doi: 10.1093/ofid/ofab040
pii: ofab040
pmc: PMC7928624
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofab040Subventions
Organisme : NIMH NIH HHS
ID : K01 MH119923
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI052074
Pays : United States
Commentaires et corrections
Type : UpdateOf
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
Références
N Engl J Med. 2020 Sep 3;383(10):993
pubmed: 32649076
Lancet. 2020 May 16;395(10236):1569-1578
pubmed: 32423584
Clin Trials. 2020 Oct;17(5):472-482
pubmed: 32674594
Clin Infect Dis. 2021 May 4;72(9):1642-1644
pubmed: 32628744
N Engl J Med. 2020 Sep 3;383(10):992-993
pubmed: 32649075
JAMA Intern Med. 2020 Nov 1;180(11):1436-1447
pubmed: 32667668
Clin Infect Dis. 2021 May 4;72(9):e206-e214
pubmed: 32674114
N Engl J Med. 2020 Nov 5;383(19):1813-1826
pubmed: 32445440
Lancet Respir Med. 2020 May;8(5):475-481
pubmed: 32105632
AAPS J. 2020 Aug 2;22(5):102
pubmed: 32743771
N Engl J Med. 2021 Feb 11;384(6):497-511
pubmed: 33264556
JAMA. 2020 Sep 15;324(11):1048-1057
pubmed: 32821939
N Engl J Med. 2020 Sep 3;383(10):993-994
pubmed: 32649077
JAMA. 2020 May 26;323(20):2052-2059
pubmed: 32320003
Drug Saf. 2020 Jul;43(7):645-656
pubmed: 32468196
Health Policy Plan. 2020 Jun 1;35(5):546-555
pubmed: 32125375
Anaesthesia. 2020 Oct;75(10):1340-1349
pubmed: 32602561
N Engl J Med. 2020 Sep 3;383(10):992
pubmed: 32649074