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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 ORCID: https://orcid.org/0000-0002-7580-7699, Coates, Maria, Cureton, Lucy, Dobson, Melissa, Dorward, Jienchi, Evans, Philip, Francis, Nick, Gbinigie, Oghenekome Abisoye, Hayward, Gail, Holmes, Jane, Hood, Kerenza ORCID: https://orcid.org/0000-0002-5268-8631, Khoo, Saye, Ahmed, Haroon ORCID: https://orcid.org/0000-0002-0634-8548, Lown, Mark, Mckenna, Micheal, Mort, Sam, Nguyen-Van-Tam, Jonathan, Rahman, Najib, Richards, Duncan B., Thomas, Nicholas, van Hecke, Oliver, Hobbs, F.D. Richard, Little, Paul, Yu, Ly-mee, Butler, Christopher C. and Petrou, Stavros 2024. 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 74 (745) , e570-e579. 10.3399/BJGP.2023.0444

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Abstract

Background: The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations. Aim: 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. Design and setting: Economic evaluation of the PANORAMIC trial in the UK. Method: 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. Results: 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. Conclusion: 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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Centre for Trials Research (CNTRR)
Publisher: Royal College of General Practitioners
ISSN: 0960-1643
Funders: NIHR
Date of First Compliant Deposit: 15 February 2024
Date of Acceptance: 20 November 2023
Last Modified: 21 Aug 2024 09:24
URI: https://orca.cardiff.ac.uk/id/eprint/166284

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