Cost-effectiveness of Remdesivir and Dexamethasone for COVID-19 Treatment in South Africa

  1. Youngji Jo
  2. Lise Jamieson
  3. Ijeoma Edoka
  4. Lawrence Long
  5. Sheetal Silal
  6. Juliet R C Pulliam
  7. Harry Moultrie
  8. Ian Sanne
  9. Gesine Meyer-Rath
  10. Brooke E Nichols

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Abstract

Background

Dexamethasone and remdesivir have the potential to reduce coronavirus disease 2019 (COVID)–related mortality or recovery time, but their cost-effectiveness in countries with limited intensive care resources is unknown.

Methods

We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed the cost-effectiveness of (1) administration of dexamethasone to ventilated patients and remdesivir to nonventilated patients, (2) dexamethasone alone to both nonventilated and ventilated patients, (3) remdesivir to nonventilated patients only, and (4) dexamethasone to ventilated patients only, all relative to a scenario of standard care. We estimated costs from the health care system perspective in 2020 US dollars, deaths averted, and the incremental cost-effectiveness ratios of each scenario.

Results

Remdesivir for nonventilated patients and dexamethasone for ventilated patients was estimated to result in 408 (uncertainty range, 229–1891) deaths averted (assuming no efficacy [uncertainty range, 0%–70%] of remdesivir) compared with standard care and to save $15 million. This result was driven by the efficacy of dexamethasone and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone for nonventilated and ventilated patients requires an additional $159 000 and averts 689 [uncertainty range, 330–1118] deaths, resulting in $231 per death averted, relative to standard care.

Conclusions

The use of remdesivir for nonventilated patients and dexamethasone for ventilated patients is likely to be cost-saving compared with standard care by reducing ICU days. Further efforts to improve recovery time with remdesivir and dexamethasone in ICUs could save lives and costs in South Africa.

Article activity feed

  1. Version published to 10.1093/ofid/ofab040
  2. ScreenIT

    SciScore for 10.1101/2020.09.24.20200196: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The model was constructed in Microsoft Excel using an Excel Visual Basic Macro to run the simulations.
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our analysis has several limitations. Firstly, the number of months ICU capacity is breached is influenced by the interplay between epidemic conditions and policy choices (which can affect ICU admission of other diseases).(19) As this will have different implications for costs and health outcomes in each scenario, it will be important to consider regional heterogeneity in epidemic conditions, health system capacity and willingness to pay in order to guide optimal treatment strategies. Second, we did not consider potential changes in the clinical course with disease progression nor change of distribution of disease severity among the patient population over time. Importantly, efficacy of remdesivir and dexamethasone in preventing mortality can be influenced by several factors – time of treatment initiation after symptom onset (20, 21), age (22), comorbidities(23), potential adverse events(24), and use of other medications(25, 26). As additional treatment options become available(27), it would also be important to collect more data on the duration of illness and its relationship to the outcome (both in terms of efficacy and safety)(24) and conduct more detailed analyses considering patient population characteristics, change of epidemic curves and local health system capacity, that can guide an optimal treatment strategy in a resource constrained setting. Third, our cost data does not include additional costs associated with adverse events management and also may not fully incor...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.09.24.20200196v1 on medRxiv