Cost-effectiveness of remdesivir and dexamethasone for COVID-19 treatment in South Africa

Abstract Background South Africa recently experienced a first peak in COVID-19 cases and mortality. Dexamethasone and remdesivir both have the potential to reduce COVID-related mortality, but their cost-effectiveness in a resource-limited setting with scant 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 cost-effectiveness of 1) administration of dexamethasone to ventilated patients and remdesivir to non-ventilated patients, 2) dexamethasone alone to both non-ventilated and ventilated patients, 3) remdesivir to non-ventilated patients only, and 4) dexamethasone to ventilated patients only; all relative to a scenario of standard care. We estimated costs from the healthcare system perspective in 2020 USD, deaths averted, and the incremental cost effectiveness ratios of each scenario.Results Remdesivir for non-ventilated patients and dexamethasone for ventilated patients was estimated to result in 1,111 deaths averted (assuming a 0-30% efficacy of remdesivir) compared to standard care, and save $11.5 million. The result was driven by the efficacy of the drugs, and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone to ventilated and non-ventilated patients requires additional $159,000 and averts 1,146 deaths, resulting in $139 per death averted, relative to standard care.Conclusions The use of dexamethasone for ventilated and remdesivir for non-ventilated patients is likely to be cost-saving compared to standard care. Given the economic and health benefits of both drugs, efforts to ensure access to these medications is paramount.40-word summary of article’s main point The use of remdesivir and dexamethasone for treatment of severe COVID-19 in South Africa is likely to be cost-saving relative to standard care. Enabling access to these medications should be prioritize to improve patient outcomes and reduce total costs..

Media Type:

Electronic Article

Year of Publication:

2021

Publication:

2021

Contained In:

bioRxiv.org - (2021) vom: 04. Apr. To Main Record - year:2021

Language:

English

Contributors:

Jo, Youngji [Author]
Jamieson, Lise [Author]
Edoka, Ijeoma [Author]
Long, Lawrence [Author]
Silal, Sheetal [Author]
Pulliam, Juliet R.C. [Author]
Moultrie, Harry [Author]
Sanne, Ian [Author]
Meyer-Rath, Gesine [Author]
Nichols, Brooke E [Author]

Links:

Volltext [Kostenfrei]

doi:

10.1101/2020.09.24.20200196

PPN (Catalogue-ID):

XBI018830145