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

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

<p><strong>Background </p></strong>The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations. <p><strong> Aim </p></strong>To evaluate the cost-effectiveness of molnu...

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Bibliographic Details
Main Authors:	Png, ME, Harris, V, Grabey, J, Hart, ND, Jani, BD, Butler, D, Carson-Stevens, A, Coates, M, Cureton, L, Dobson, M, Dorward, J, Evans, P, Francis, N, Gbinigie, OA, Hayward, G, Holmes, J, Hood, K, Khoo, S, Ahmed, H, Lown, M, McKenna, M, Mort, S, Nguyen-Van-Tam, J, Rahman, N, Richards, DB, Thomas, N, van Hecke, O, Hobbs, FR, Little, P, Yu, L-M, Butler, CC, Petrou, S
Other Authors:	PANORAMIC Trial Collaborators
Format:	Journal article
Language:	English
Published:	Royal College of General Practitioners 2024

Description
Summary:	<p><strong>Background </p></strong>The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations. <p><strong> Aim </p></strong>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 6 months. <p><strong> Design and setting </p></strong>An economic evaluation of the PANORAMIC trial in the UK. <p><strong> Method </p></strong>A cost-utility analysis that adopted a UK NHS and personal social services perspective and a 6-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. <p><strong> Results </p></strong>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 = 0.0044 to 0.0067) than usual care (mean incremental cost per QALY of £81 190). Sensitivity and subgroup analyses showed similar results, except for those aged ≥75 years, with a 55% probability of being cost-effective at a £30 000 per QALY threshold. Molnupiravir would have to be priced around £147 per course to be cost-effective at a £15 000 per QALY threshold. <p><strong> Conclusion </p></strong>At the current cost of £513 per course, molnupiravir is unlikely to be cost-effective relative to usual care over a 6-month time horizon among mainly vaccinated patients with COVID-19 at increased risk of adverse outcomes, except those aged ≥75 years.