Epidemiology and Health

COVID-19: Original Article

Model-based cost-effectiveness analysis of oral antivirals against SARS-CoV-2 in Korea: Youngji Jo, Sun Bean Kim, Munkhzul Radnaabaatar, Kyungmin Huh, Jin-Hong Yoo, Kyong Ran Peck, Hojun Park, Jaehun Jung; Epidemiol Health. 2022;44:e2022034. Published online March 12, 2022; DOI: https://doi.org/10.4178/epih.e2022034

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Many countries have authorized the emergency use of oral antiviral agents for patients with mild-to-moderate cases of coronavirus disease 2019 (COVID-19). We assessed the cost-effectiveness of these agents for reducing the number of severe COVID-19 cases and the burden on Korea’s medical system.

METHODS

Using an existing model, we estimated the number of people who would require hospital/intensive care unit (ICU) admission in Korea in 2022. The treatment scenarios included (1) all adult patients, (2) elderly patients only, and (3) adult patients with underlying diseases only, compared to standard care. Based on the current health system capacity, we calculated the incremental costs per severe case averted and hospital admission for each scenario.

RESULTS

We estimated that 236,510 COVID-19 patients would require hospital/ICU admission in 2022 with standard care only. Nirmatrelvir/ritonavir (87% efficacy) was predicted to reduce this number by 80%, 24%, and 17% when targeting all adults, adults with underlying diseases, and elderly patients (25, 8, and 4%, respectively, for molnupiravir, with 30% efficacy). Nirmatrelvir/ritonavir use is likely to be cost-effective, with predicted costs of US$8,878, US$8,964, and US$1,454, per severe patient averted for the target groups listed above, respectively, while molnupiravir is likely to be less cost-effective, with costs of US$28,492, US$29,575, and US$7,915, respectively.

CONCLUSIONS

In Korea, oral treatment using nirmatrelvir/ritonavir for symptomatic COVID-19 patients targeting elderly patients would be highly cost-effective and would substantially reduce the demand for hospital admission to below the capacity of the health system if targeted to all adult patients instead of standard care.

Summary

Korean summary
본 연구는 감염병 수리모형을 바탕으로 두가지 항바이러스제의 (nirmatrelvir/ritonavir와 molnupiravir) 비용 효익을 평가하였다. 본 모델에 따르면, 2022년 한국에서, 현재 의료시스템의 수용한계를 넘는 코로나 19 대유행이 발생할 때, nirmatrelvir/ritonavir 를 코로나 감염 및 증상 있는 고령층 환자들을 대상으로 투여할 경우 높은 비용 효익이 기대되고 (중증환자 1명 감소효과에$1,454 비용소요), 성인 환자 대상으로 투여할 경우, (molnupiravir이나 nirmatrelvir/ritonavir를 투여하지 않는) 일반 치료에 비해서 전체 입원 수요를 80% 줄일 것으로 기대된다.

Key Message
Given an expected high epidemic resurgence in 2022 that could exceed South Korea’s current health system capacity, oral treatment using nirmatrelvir/ritonavir for symptomatic COVID-19 patients may be a highly cost-effective solution if targeted to elderly patients ($1,454 per severe case averted) and substantially reduce the demand for hospital admission (80%, 188,478 patients) below the capacity of the health system if targeted to all adult patients compared to standard care.

Citations

Citations to this article as recorded by

Cost-Utility Model of Nirmatrelvir/Ritonavir in Brazil: Analysis of a Vaccinated Population
Ricardo R.A. Fernandes, Bruno M. Barros, Milene R. da Costa, Carlos A.S. Magliano, Bernardo R. Tura, Quenia Cristina D. Morais, Marisa Santos
Value in Health Regional Issues.2024; 40: 74. CrossRef
Cost-effectiveness of nirmatrelvir/ritonavir for high-risk adult outpatients with COVID-19 in Japan
Takahito Mizuno, Yu Kondo, Mikiyasu Sakai, Kenichi Saneyasu, Ryota Kojima, Yoshio Miyake
Journal of Infection and Chemotherapy.2024;[Epub] CrossRef
Impact of the Use of Oral Antiviral Agents on the Risk of Hospitalization in Community Coronavirus Disease 2019 Patients (COVID-19)
Terry Cheuk-Fung Yip, Grace Chung-Yan Lui, Mandy Sze-Man Lai, Vincent Wai-Sun Wong, Yee-Kit Tse, Bosco Hon-Ming Ma, Elsie Hui, Maria K W Leung, Henry Lik-Yuen Chan, David Shu-Cheong Hui, Grace Lai-Hung Wong
Clinical Infectious Diseases.2023; 76(3): e26. CrossRef
Nirmatrelvir plus ritonavir in COVID-19: a profile of its use
Hannah A. Blair
Drugs & Therapy Perspectives.2023; 39(2): 41. CrossRef
Cost-effectiveness analysis of ritonavir boosted nirmatrelvir for adult outpatients with mild to moderate COVID-19 in a European health system
Philip Wikman-Jorgensen, José María Ibarra, Carlos Devesa, Jorge Peris, Jara Llenas-García
European Journal of Internal Medicine.2023; 118: 133. CrossRef
Assessing the cost-effectiveness of annual COVID-19 booster vaccination in South Korea using a transmission dynamic model
Wongyeong Choi, Eunha Shim
Frontiers in Public Health.2023;[Epub] CrossRef
Multi-Faceted Analysis of COVID-19 Epidemic in Korea Considering Omicron Variant: Mathematical Modeling-Based Study
Youngsuk Ko, Victoria May Mendoza, Renier Mendoza, Yubin Seo, Jacob Lee, Jonggul Lee, Donghyok Kwon, Eunok Jung
Journal of Korean Medical Science.2022;[Epub] CrossRef
Adjusting non-pharmaceutical interventions based on hospital bed capacity using a multi-operator differential evolution
Victoria May P. Mendoza, Renier Mendoza, Jongmin Lee, Eunok Jung
AIMS Mathematics.2022; 7(11): 19922. CrossRef
The Possible Impact of Nationwide Vaccination on Outcomes of the COVID-19 Epidemic in North Korea: A Modelling Study
Sung-mok Jung, Jaehun Jung
Journal of Korean Medical Science.2022;[Epub] CrossRef
Medications for early treatment of COVID ‐19 in Australia
Adam Polkinghorne, James M Branley
Medical Journal of Australia.2022;[Epub] CrossRef
Comparative effectiveness of sotrovimab and molnupiravir for prevention of severe covid-19 outcomes in patients in the community: observational cohort study with the OpenSAFELY platform
Bang Zheng, Amelia C A Green, John Tazare, Helen J Curtis, Louis Fisher, Linda Nab, Anna Schultze, Viyaasan Mahalingasivam, Edward P K Parker, William J Hulme, Sebastian C J Bacon, Nicholas J DeVito, Christopher Bates, David Evans, Peter Inglesby, Henry D
BMJ.2022; : e071932. CrossRef
Treatment Options for Patients With Mild-to-Moderate Coronavirus Disease 2019 in Korea
Jaehyun Jeon, BumSik Chin
Journal of Korean Medical Science.2022;[Epub] CrossRef

Original Article

Cost-effectiveness analysis of low density lipoprotein cholesterol-lowering therapy in hypertensive patients with type 2 diabetes in Korea: single-pill regimen (amlodipine/atorvastatin) versus double-pill regimen (amlodipine+atorvastatin): Ji-Hyun Park, Yong-Ho Lee, Su-Kyoung Ko, Bong-Soo Cha; Epidemiol Health. 2015;37:e2015010. Published online February 22, 2015; DOI: https://doi.org/10.4178/epih/e2015010

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Single-pill combination therapy (amlodipine/atorvastatin) might be more effective than double-pill therapy (amlodipine+atorvastatin) in patients with diabetes and concomitant hypertension requiring statin therapy. We compared the cost-effectiveness of a single-pill with that of double-pill for control of low density lipoprotein cholesterol (LDL-C) levels, with the ultimate goal of cardiovascular disease prevention, in these patients using a cost-effectiveness analysis model that considered medication adherence.

METHODS

Effectiveness was defined as the percentage (%) attainment of target LDL-C levels (<100 mg/dL) based on adherence for each therapy. Adherence was defined as compliance to medication (≥80% proportion of days covered). A systematic review of the literature was conducted to determine the proportion of patients who were adherent and target goal attainment based on adherence level. The annual medication costs were based on the adherence levels for each regimen. The average cost-effectiveness ratio (ACER) was calculated as the cost per % attainment of the target LDL-C level.

RESULTS

The ACER for the single-pill regimen was lower than for the double-pill regimen (4,123 vs. 6,062 Korean won per 1% achievement of target goal). Compared with the double-pill, the medication costs were approximately 32% lower with the single-pill.

CONCLUSION

A single-pill for reductions in LDL-C is cost-effective compared with double-pill in hypertensive patients with type 2 diabetes.

Summary

Korean summary
본 연구는 고혈압을 동반한 당뇨환자에게 혈중지질의 추가적인 관리가 필요한 경우 단일복합제제(Amlodipine/Atorvastatin) 투여와 단일제제 병용 (Amlodipine + Atorvastatin) 투여의 두 대안에서 복약 순응도를 고려한 비용-효과성을 비교 분석하였다. 복약순응도의 차이는 치료결과에도 영향을 미치게 되어 복약순응군에서의 치료효과가 비순응군의 효과보다 더 우수하므로 비용-효과 분석 결과 단일복합제 투여군이 단일제제 병용투여군과 비교하였을때 더 효율적인 대안임을 확인할 수 있다.

Citations

Citations to this article as recorded by

Fixed‐dose combination of amlodipine and atorvastatin improves clinical outcomes in patients with concomitant hypertension and dyslipidemia
Chia‐Pin Lin, Ying‐Chang Tung, Fu‐Chih Hsiao, Chia‐Hung Yang, Yi‐Wei Kao, Yu‐Sheng Lin, You‐Chia Chu, Pao‐Hsien Chu
The Journal of Clinical Hypertension.2020; 22(10): 1846. CrossRef
Bempedoic acid for high-risk patients with CVD as adjunct lipid-lowering therapy: A cost-effectiveness analysis
Kanila Perera, Ning Kam, Zanfina Ademi, Danny Liew, Ella Zomer
Journal of Clinical Lipidology.2020; 14(6): 772. CrossRef
Efficacy and Tolerability of Telmisartan/Amlodipine and Rosuvastatin Coadministration in Hypertensive Patients with Hyperlipidemia: A Phase III, Multicenter, Randomized, Double-blind Study
Tae-Seok Kim, Seung-Woon Rha, Seok-Yeon Kim, Dae-Gyun Park, Ki-Chul Sung, Myung-Ho Yoon, Kye-Hoon Kim, Han-Cheol Lee, Woo-Sik Kim, Yong-Jin Kim, Jeong-Cheon Ahn, Moo-Yong Rhee, Dong-Hun Cha, Byung-Su Yoo, Sang-Ho Park, Ki-Dong Yoo, Dong-Woon Jeon, Young-W
Clinical Therapeutics.2019; 41(4): 728. CrossRef
Formulations of Amlodipine: A Review
Muhammad Ali Sheraz, Syed Furqan Ahsan, Marium Fatima Khan, Sofia Ahmed, Iqbal Ahmad
Journal of Pharmaceutics.2016; 2016: 1. CrossRef

Review

Methodological Review of Cost Effectiveness Analysis of Cancer Screening.: Ki Taig Jung; Korean J Epidemiol. 1998;20(1):13-31.

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Abstract PDF: Abstract
The role of economic evaluation for medical services can be summarixed as providing objective criteria for rational bgudget allocation. With medical and epidemiologial studies, cost effectiveness analysis of cancer screening will provide evidence for allocating more financial resources for cancer screening. This study reviewed comprehensive literature of cancer screening for cervical cancer and breast cancer. Through the extensive review of the literature, I suggest crucial issues of cancer screening and checkpoints in designing costeffectiveness analyses of cervical and breast cancers. The issues of cervical and breast cancer screening include ages of starting and terminating mass screening, screening interval and frequency, false positive rate, false negative rate, analytical models, and sensitivity analysis. In addition, cost effectiveness analysis of breast cancer should consider effects of screening methods-self examination, clinical examination, and mammography-that varies across different nations on cost effectiveness ratio. Study results of most issues would be relevant for performing cost effectiveness analysis of cancer screening in Korea. However, difference in incidence rate, medical fees and reimbursement by insurance across nations should be considered in designing cost effectiveness analysis.; Summary

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