Budget impact of adopting nirmatrelvir-ritonavir for treating COVID-19 in a large integrated healthcare system
Does it make financial sense for a healthcare system to buy and prescribe Paxlovid (nirmatrelvir-ritonavir) to COVID-19 patients?
College of Health researcher(s)
Abstract
Background
Understanding the budget impact of prescribing nirmatrelvir-ritonavir (NR) for COVID-19 can inform procurement and allocation strategies in large healthcare systems.
Methods
We assessed the budget impact of providing NR treatment in the Veterans Health Administration (VHA) for all treatment-eligible Veterans (laboratory-confirmed COVID-19 illness from April 2022 through March 2023) and by clinical subgroups, including predicted hospitalization/death risk quartile. We used decision tree models that included 30-day emergency department (ED) visits, hospitalizations, and death to assess the budget impact of NR. Transition probabilities were derived from a target trial emulation of NR effectiveness in the same population. We priced NR at $1,031/course and used cost accounting records to estimate ED ($1,420), hospitalization ($22,419), and hospitalization with ICU ($59,918) costs.
Results
Among 138,261 treatment-eligible Veterans, 18% (n=24,892) were prescribed NR. Treating all patients compared with treating none reduced healthcare costs by -$20 million (uncertainty bound [UB]: -70 to 0.23) but increased total budget costs by +$122 million (UB: 73 to 143) due to purchasing NR. Targeted treatment of patients in the highest risk quartile (n=19,406) achieved healthcare cost savings of -$17 million (UB: -49 to -3) and a modest total budget increase (+$3 million, UB: -29 to 17).
Conclusions
NR may reduce 30-day COVID-19 healthcare utilization costs, but the high cost of purchasing NR is likely to exceed those savings. Price reductions are necessary for NR to be a financially viable treatment for healthcare systems. Risk-informed allocation strategies can help maximize treatment benefits and minimize budget increases.