Remdesivir and dexamethasone as tools to relieve hospital care systems stressed by COVID-19: A modelling study on bed resources and budget impact

  1. Guillaume Béraud
  2. Jean-François Timsit
  3. Henri Leleu

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Abstract

Remdesivir and dexamethasone are the only drugs providing reductions in the lengths of hospital stays for COVID-19 patients. We assessed the impacts of remdesivir on hospital-bed resources and budgets affected by the COVID-19 outbreak. A stochastic agent-based model was combined with epidemiological data available on the COVID-19 outbreak in France and data from two randomized control trials. Strategies involving treating with remdesivir only patients with low-flow oxygen and patients with low-flow and high-flow oxygen were examined. Treating all eligible low-flow oxygen patients during the entirety of the second wave would have decreased hospital-bed occupancy in conventional wards by 4% [2%; 7%] and intensive care unit (ICU)-bed occupancy by 9% [6%; 13%]. Extending remdesivir use to high-flow-oxygen patients would have amplified reductions in ICU-bed occupancy by up to 14% [18%; 11%]. A minimum remdesivir uptake of 20% was required to observe decreases in bed occupancy. Dexamethasone had effects of similar amplitude. Depending on the treatment strategy, using remdesivir would, in most cases, generate savings (up to 722€) or at least be cost neutral (an extra cost of 34€). Treating eligible patients could significantly limit the saturation of hospital capacities, particularly in ICUs. The generated savings would exceed the costs of medications.

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  1. Version published to 10.1371/journal.pone.0262462
  2. ScreenIT

    SciScore for 10.1101/2021.02.24.21252355: (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

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study presents some limitations. The benefit of remdesivir and dexamethasone appears highly dependent on the timing of introduction following symptoms onset. However, in the absence of data, we were not able to assess the impact of this timing on the results. Therefore, it seems reasonable to highly recommend the early use of remdesivir and dexamethasone when indicated to maximize their effects. This would be before the 10th day after the onset of symptoms for remdesivir and one week after for dexamethasone. In addition, regarding the limited numbers of data sources available, we had to rely on only two RCT studies. It should be noted that we used the median time to recovery as a proxy for the length of stay in the absence of the availability of precise data. For the same reason, we did not use data from the SOLIDARITY trial (32) because data on the length of stay were not explicitly and precisely provided. Eventually, the standard of care dramatically changed between the ACTT trial period (March-April 2021) and the current period, with more patients being treated with high-flow oxygen or non-invasive ventilation instead of invasive ventilation. Our analysis supposes that the effect of remdesivir will remain unchanged on patients treated with high-flow oxygen, as we set the model’s parameters according to the ACTT-1 patient distribution. In conclusion, our results support the wide use of remdesivir among patients with low-flow and high-flow oxygen to flatten the epidemic ...

    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.

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  3. Version published to 10.1101/2021.02.24.21252355v1 on medRxiv