COVID-19 excess mortality and the cost-effectiveness of treatments options in COVID-19 hospitlized patients

Abstract

Objectives: Estimate the COVID-19 specific mortality for Mexico’s population aged 45 years and older and quantify the health outcomes, costs, and cost-effectiveness of treatments that aim to reduce COVID-19-specific mortality using a microsimulation model. Methods: We used publicly available data for COVID-19 deaths to estimate the COVID-19-specific mortality for Mexico’s population and developed a decision-analytic microsimulation model that simulates cohorts of intubated and non-intubated hospitalized COVID-19 patients. We used this model to evaluate treatments that have shown effectiveness in reducing mortality among COVID-19 patients: 1) Remdesivir; 2) Remdesivir and Baricitinib, and 3) no treatment for non-intubated patients. For intubated patients, we compared: 1) Dexamethasone; 2) no treatment. Sensitivity Analysis were conducted. Results: The COVID-19-specific mortality rate increases with age and men face higher mortality rates than women. The non-intubated cohort lives 5.27 discounted QALYs and experiences costs of $262,900 (Mexican pesos [$]) without COVID-19 treatment, 5.97 QALYs and $355,600 with Remdesivir alone, and 6.72 QALYs and $422,400 with Remdesivir and Baricitinib. For intubated hospitalized patients, Dexamethasone yields 2.72 discounted QALYs with lifetime costs of $709,000, while no COVID-19 treatment yields 1.45 QALYs and costs of $674,900. Conclusions: Our analysis demonstrates that treating COVID-19 hospitalized patients in Mexico is cost-effective compared to no treatment. Remdesivir combined with Baricitinib is a high-value strategy for all non-intubated hospitalized patients and Dexamethasone for intubated patients.