Cost-Effectiveness of Nirmatrelvir/Ritonavir in COVID-19 Patients at High-Risk for Progression in Spain

The objective was to estimate the cost-effectiveness of nirmatrelvir/ritonavir (NMV/r) in treating adults with COVID-19 at high-risk of developing severe COVID-19 who do not require supplemental oxygen, compared to no treatment, from the Spanish National Health System (NHS) perspective. A decision-tree for the first year followed by a two-state Markov model with annual cycles for a lifetime horizon was developed. A cohort of 1000 high-risk, symptomatic COVID-19 patients entered the decision-tree for each comparator, divided into hospitalized patients, considering their level of care, and outpatients, for whom only symptom duration was considered. Vaccination status of patients and COVID-19-specific mortality for hospitalized patients were considered. NMV/r efficacy in reducing hospitalizations, deaths and symptom days was applied. Patient quality of life and costs were included (€2024). All the parameters and assumptions were validated by experts. The model reported outputs including costs, quality-adjusted life-years (QALYs) and cost per QALY gained. NMV/r was dominant compared to no treatment, with a decrease in cost per patient of €169.69 and an increase in QALYs of 0.05. NMV/r is a dominant option compared to no treatment in high-risk adult patients with symptomatic COVID-19 not requiring supplemental oxygen, from the Spanish NHS perspective.