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Outpatient Therapies for COVID-19: How Do We Choose?
Todd C Lee1,2,3, Andrew M Morris4, Steven A Grover3,5
1Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.
Several outpatient therapies can prevent COVID-19 hospitalization, with varying efficacy and cost. Nirmatrelvir/ritonavir and remdesivir showed high efficacy, while colchicine, fluvoxamine, and inhaled corticosteroids were cost-effective. Treatment choice requires balancing these factors.
Area of Science:
- Infectious Diseases
- Pharmacoeconomics
- Public Health
Background:
- Outpatient therapies for COVID-19 have demonstrated reduced hospitalization rates in clinical trials.
- Selecting the optimal therapy involves considering drug efficacy, toxicity, cost, availability, and healthcare infrastructure.
Purpose of the Study:
- To evaluate the efficacy of various outpatient COVID-19 treatments.
- To estimate the cost per hospitalization prevented for each therapy to aid comparative decision-making.
Main Methods:
- Relative risk for hospitalization was extracted from randomized controlled trials and meta-analyzed where necessary.
- Number needed to treat (NNT) was calculated assuming a 5% baseline hospitalization risk.
- Cost per hospitalization prevented was compared to the estimated Medicare cost of $21,752.
Main Results:
- NNTs varied, with nirmatrelvir/ritonavir (24), remdesivir (28), sotrovimab (25), casirivimab/imdevimab (29), and bamlanivimab/etesevimab (29) showing higher efficacy.
- Colchicine (91), fluvoxamine (80), inhaled corticosteroids (72), and nirmatrelvir/ritonavir were found to be cost-effective, with costs per hospitalization prevented below the Medicare estimate.
Conclusions:
- Multiple effective outpatient COVID-19 therapies are available globally.
- Differences in efficacy, toxicity, cost, and administration complexity necessitate a framework for treatment selection.
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