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

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

BACKGROUND: Dexamethasone and remdesivir have the potential to reduce COVID-related mortality or recovery time, but their cost-effectiveness in countries with limited 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 408 [uncertainty range: 229-1891] deaths averted (assuming no efficacy [uncertainty range: 0-70%] of remdesivir) compared to standard care, and save $15 million. The result was driven by the efficacy of dexamethasone, and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone to non-ventilated and ventilated patients requires additional $159,000 and averts 689 [uncertainty range: 330-1118] deaths, resulting in $231 per death averted, relative to standard care. CONCLUSIONS: The use of remdesivir for non-ventilated patients and dexamethasone for ventilated is likely to be cost-saving compared to standard care by reducing ICU days. Further efforts to improve recovery time with remdesivir and dexamethasone in ICU could save lives and costs in South Africa.