Model-based cost-effectiveness analysis of oral antivirals against SARS-CoV-2 in Korea

Countries authorized the emergency use of oral antiviral agents in patients with mild-to-moderate COVID-19. We assessed the cost-effectiveness of introducing these novel oral antiviral agents to reduce the number of severe patients infected with SARS-CoV-2 and the burden of the medical systems. From the existing COVID-19 Epidemiology Model, we projected the number of people who require hospital/ICU admissions in Korea in 2022. Treatment scenarios included (i) all adults, (ii) elderly, and (iii) adult patients with underlying diseases administered molnupiravir or nirmatrelvir/ritonavir vis-a-vis standard care. Under the current health systems capacity, we calculate the incremental cost per severe patient averted and per net admission for each scenario relative to standard care. An estimated, 236,510 COVID-19 patients would require hospital/ICU in Korea in 2022 with standard care. Nirmatrelvir/ritonavir (87% efficacy) is expected to reduce the number of severe patients requiring hospital/ICU admissions by 80%, 24%, and 17% (25%, 8%, and 4% by molnupiravir with 30% efficacy) when targeting all adults, adults with underlying diseases, and elderly patients, respectively. Administration of Nirmatrelvir/ritonavir may be cost-effective as $1,454, $8,878, and $8,964 (while molnupiravir may be less likely cost-effective as $7,915, $28,492, $29,575) per severe patient averted if targeted respectively to the target group mentioned above, compared to standard care. In Korea, oral nirmatrelvir/ritonavir treatment of symptomatic COVID-19 patients can be highly cost-effective if targeted to elderly patients while substantially reducing hospital admission demand below the health systems capacity limit if all adult patients are targeted compared to standard care.