The prices of drugs used to treat COVID-19 for those at risk of serious illness are “reasonably aligned” with how much they help patients, according to a draft report from drug-pricing research organization the Institute for Clinical and Economic Review (ICER).
The report assessed Pfizer’s Paxlovid and Merck molnupiravir – both recently authorized antiviral pills – as well as sotrovimab, an intravenous monoclonal antibody drug developed by GlaxoSmithKline and Vir Biotechnology.
The three treatments – approved on an emergency basis for people with mild-to-moderate COVID-19 deemed at risk of progressing to serious illness – have been purchased by the U.S. government and are being distributed free-of-charge to healthcare providers.
The U.S. government has paid around $530 for a 5-day course of Paxlovid, $700 per five-day course of molnupiravir, and $2,100 for a course of sotrovimab – the lone available antibody treatment shown to work against the now dominant Omicron variant of the virus.
In clinical trials, ICER said molnupiravir cut hospitalization rates for high-risk patients by 30%, compared with 88% risk reduction for Paxlovid and 79% for sotrovimab.
“Right now the alignment of the price and benefits look reasonable,” ICER President Steve Pearson told Reuters.
The Pfizer and Merck drugs are meant to be taken at home, while GSK’s antibody is administered in hospital or infusion centers.
ICER also analyzed the cost-effectiveness of fluvoxamine, a 40-year-old generic pill used to treat conditions such as obsessive-compulsive disorder and depression at a cost of about $10 for a 10-day course.
Researchers from the University of Minnesota applied in December for emergency authorization of fluvoxamine for high-risk COVID patients after studies showed that the anti-depressant, which also has anti-inflammatory properties, reduced hospitalization rates by 32%.
ICER uses a decades-old formula called the quality-adjusted life year (QALY) – the cost of one year of good health for one patient – to estimate fair value.
By that and other measures, ICER said fluvoxamine offers the best value at $6,000 per QALY gained. It calculated Paxlovid was second at $18,000 per QALY gained, followed by molnupiravir at $55,000 and sotrovimab at $69,000.
Pearson said the pandemic has lots of “moving parts” and if the risk of hospitalization from infection with Omicron or a future variant proves to be lower, ICER’s analysis would change.
The analysis applies only to use of the drugs for patients at elevated risk of severe COVID-19. If the treatments were used in lower-risk populations, “their cost effectiveness would be significantly reduced,” ICER said.
ICER plans to accept public comment on its draft and issue an updated evidence report in late March.
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