Cost-utility analysis of molnupiravir plus usual care versus usual care alone as early treatment for community-based adults with COVID-19 and increased risk of adverse outcomes in the UK PANORAMIC trial

Png, May Ee; Harris, Victoria; Grabey, Jenna; Hart, Nigel David; Jani, Bhautesh Dinesh; Butler, Daniel; Carson-Stevens, Andrew; Coates, Maria; Cureton, Lucy; Dobson, Melissa; Dorward, Jienchi; Evans, Philip; Francis, Nick; Gbinigie, Oghenekome Abisoye; Hayward, Gail; Holmes, Jane; Hood, Kerenza; Khoo, Saye; Ahmed, Haroon; Lown, Mark; Mckenna, Micheal; Mort, Sam; Nguyen-Van-Tam, Jonathan; Rahman, Najib; Richards, Duncan B; Thomas, Nicholas; Van Hecke, Oliver; Hobbs, FD Richard; Little, Paul; Yu, Ly-Mee; Butler, Christopher C; Petrou, Stavros

Abstract

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 six months. Economic evaluation of the PANORAMIC trial in the UK. A cost-utility analysis that adopted a UK National Health Service and personal social services perspective and a six-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 0.004 to 0.007) than usual care (mean incremental cost per QALY of £81190). Sensitivity and subgroup analyses showed similar results, except those aged ≥75 years with a 55% probability of being cost-effective at a £30000 per QALY threshold. Molnupiravir would have to be priced around £147 per course to be cost-effective at a £15000 per QALY threshold. Molnupiravir at the current cost of £513 per course is unlikely to be cost-effective relative to usual care over a six-month time horizon among mainly vaccinated COVID-19 patients at increased risk of adverse outcomes, except those aged ≥75 years.

Citation

Png, M. E., Harris, V., Grabey, J., Hart, N. D., Jani, B. D., Butler, D., …Petrou, S. (in press). Cost-utility analysis of molnupiravir plus usual care versus usual care alone as early treatment for community-based adults with COVID-19 and increased risk of adverse outcomes in the UK PANORAMIC trial. British Journal of General Practice, Article 0444. https://doi.org/10.3399/bjgp.2023.0444

• Journal Article Type: Article
• Acceptance Date: Nov 20, 2023
• Online Publication Date: Jan 16, 2024
• Deposit Date: Jan 19, 2024
• Publicly Available Date: Jan 16, 2024
• Journal: British Journal of General Practice
• Print ISSN: 0960-1643
• Electronic ISSN: 1478-5242
• Publisher: Royal College of General Practitioners
• Peer Reviewed: Peer Reviewed
• Article Number: 0444
• DOI: https://doi.org/10.3399/bjgp.2023.0444
• Keywords: COVID-19, cost-effective, molnupiravir
• Public URL: https://nottingham-repository.worktribe.com/output/29839613
• Additional Information: Received 25 August 2023 Revised 03 November 2023 Accepted 20 November 2023; Accepted Manuscript To access the most recent version of this article, please click the DOI URL in the line above. Commons Attribution 4.0 License (http://creativecommons.org/licenses/by/4.0/). Published by British Journal of General Practice. For editorial process and policies, see: https://bjgp.org/authors/bjgp-editorial-process-and-policies When citing this article please include the DOI provided above. Author Accepted Manuscript This is an 'author accepted manuscript': a manuscript that has been accepted for publication in British Journal of General Practice, but which has not yet undergone subediting, typesetting, or correction. Errors discovered and corrected during this process may materially alter the content of this manuscript, and the latest published version (the Version of Record) should be used in preference to any preceding versions