Objectives: This study aimed to estimate the cost-effectiveness of remdesivir, the first novel therapeutic to receive Emergency
Use Authorization for the treatment of hospitalized patients with COVID-19, and identify key drivers of value to guide future
pricing and reimbursement efforts.
Methods: A Markov model evaluated the cost-effectiveness of remdesivir in patients hospitalized with COVID-19 from a US
healthcare sector perspective. A lifetime time horizon captured potential long-term costs and outcomes. Model outcomes
included discounted total costs, life-years, and quality-adjusted life-years (QALYs). Remdesivir was modeled as an addition
to standard of care and compared with standard of care alone, including dexamethasone for patients requiring respiratory
support. COVID-19 hospitalizations were assumed to be reimbursed through a single payment based on the respiratory
support received alongside a remdesivir carveout payment in the base case. Sensitivity and scenario analyses identified
key drivers.
Results: At a unit price of $520 per vial and assuming no survival benefit with remdesivir, the incremental cost-effectiveness
was $298 200/QALY for patients with moderate to severe COVID-19 and $1847 000/QALY for patients with mild COVID-19.
Although current data do not support a survival benefit, if one was assumed, the cost-effectiveness estimate was $50 100/
QALY for the moderate to severe population and $103 400/QALY for the mild population. Another key driver included the
hospitalization payment structure (per diem vs bundled payment).
Conclusions: With the current evidence available, remdesivir’s price is too high to align with its expected health gains for
hospitalized patients with COVID-19. Results from this study provide a rationale for iterative health technology assessment.