Cost-effectiveness of Baricitinib Compared with Standard of Care in Hospitalized Patients With COVID-19 in the United States: A Modelling Study

Ohsfeldt, Robert; Kelton, Kari; Klein, Tim; Belger, Mark; Mc Collam, Patrick L.; Spiro, Theodore; Burge, Russel; Ahuja, Neera

Purpose The COV-BARRIER Phase 3 trial demonstrated that treatment with baricitinib, an oral selective Janus kinase 1/2 inhibitor, in addition to standard of care significantly reduced mortality over 28 days in hospitalized COVID-19 participants, with a similar safety profile to standard of care. We assessed the cost-effectiveness of baricitinib plus standard of care versus standard of care alone (which included systemic corticosteroids and remdesivir) in patients hospitalized in the United States with COVID-19. Methods An economic model was developed in Microsoft Excel to simulate the inpatient stay, discharge to post-acute care, and recovered patients. Costs modelled included payer costs, hospital costs, and indirect costs. Benefits modelled included life years, quality-adjusted life years, deaths avoided, and use of mechanical ventilation avoided. The primary analysis was performed from a payer perspective over a lifetime horizon; a secondary analysis was also performed from the hospital perspective. The base case analysis modelled the numerical differences in treatment effectiveness observed in the COV-BARRIER trial. Scenario analyses were also performed in which the clinical benefit of baricitinib was limited to the statistically significant reduction in mortality demonstrated in the trial. Findings In the base case payer perspective, combination treatment with baricitinib plus standard of care resulted in an incremental total cost of $17,276, a total quality-adjusted life year (QALY) gain of 0.6703, and a total life-year gain of 0.837 compared with standard of care alone. The addition of baricitinib also increased survival by 5.1% and reduced the use of mechanical ventilation by 1.6%. The base-case incremental cost-effectiveness ratios were $25,774 per QALY gained and $20,638 per life year gained; the “mortality only” scenario analysis yielded similar results of $26,862 per QALY gained and $21,433 per life year gained. For the hospital perspective, combination treatment with baricitinib plus standard of care was more effective and less costly than standard of care alone in the base case, and it resulted in an incremental cost of $38,964 per death avoided in the “mortality only” scenario. Implications Our study showed that adding baricitinib to standard of care is cost effective for hospitalized COVID-19 patients in the United States. Cost effectiveness was demonstrated for both payer and hospital perspectives. These findings were robust to sensitivity analyses and to conservative assumptions limiting the clinical benefits of baricitinib to the statistically significant reduction in mortality demonstrated in the COV-BARRIER trial.