Paxlovid, other COVID-fighting medications more cost-effective than hospitalizations, Montreal study finds

Shortly after Health Canada green-lit the COVID-treating drug Paxlovid, researchers from the Research Institute of the McGill University Health Centre published a study comparing the efficacy and costs of various medications used to combat the virus, including this new addition from Pfizer. 

The study found that use of Paxlovid and some other treatments is more cost effective than hospitalization and could reduce the strain on the health network.

Numerous drugs have been repurposed to treat COVID-19 since the pandemic began, from the antidepressant ‘fluvoxamine’ to the gout treatment ‘colchicine.’ But Paxlovid is the first at-home drug designed specifically for the virus to hit the market in Canada. The antiviral medication is prescribed and taken orally, making it a promising treatment against mild-to-moderate cases.

Senior author of the study Dr. Emily McDonald said in a press release that the aim of the research is to help medical professionals determine the most effective and cost efficient approaches to managing COVID-19. 

“Available drugs, whether repurposed or new, differ in efficacy, toxicity, cost and complexity of administration. We felt it was important to conduct this study to facilitate comparative decision-making regarding treatment choice,” she said.

The study was published Wednesday in the Oxford journal Open Forum Infectious Diseases.

MONEY SAVERS

When measuring the cost of the drug versus its ability to prevent hospitalization, the study found that Paxlovid, fluvoxamine, colchicine, and inhaled corticosteroids are below the estimated hospitalization cost, which averages at $21,752 per admission.

Paxlovid (Nirmatrelvir-Ritonavir)

Researchers found that Paxlovid is most effective in preventing hospitalizations.

• Prevented hospitalizations: One out of every 24 patients
• Cost per prevented hospitalization: $12,720

Health Canada says a prescription of the medication can be given to anyone over 18 who is at risk of becoming seriously ill from the virus.  

Fluvoxamine 

Fluvoxamine, on the other hand, averts far fewer hospitalizations but for a fraction of the cost.

• Prevented hospitalizations: One out of every 80 patients
• Cost per prevented hospitalization: $1,122

The drug is sold under the name Luvox and is commonly used to treat obsessive-compulsive disorder and depression. 

In a clinical trial ouside from this particular study, some of the same McGill researchers are examining the effects of fluvoxamine more closely. However, Ontario is the only province so far to list the drug as a treatment to be considered for COVID-19 outside of clinical trials.  

Colchicine

Colchicine, normally used for the treatment and prevention of gout flare ups, proved to be the least effective medication in the study in terms of reducing hospital admissions.

• Prevented hospitalizations: One out of every 91 patients
• Cost per prevented hospitalization: $3,333

In 2021, a controversial study from the Montreal Heart Institute suggested colchicine was a promising therapeutic approach for COVID-19 patients, but the results of the study and its methodology have since been widely contested.  

Inhaled corticosteroids 

Inhaled corticosteroids are normally used to treat asthma.

• Prevented hospitalizations: One out of every 72 patients
• Cost per prevented hospitalization: $9,475  

 

PRICIER TREATMENTS

While other antiviral drugs prove to be nearly as effective in curbing hospitalizations as Paxlovid, according to the study, they are frequently more expensive and difficult to obtain.

Remdesivir

Remdesivir, which was originally used to treat Ebola, was approved for use by the Canadian government in July 2020.

• Prevented hospitalizations: One out of every 28 patients
• Cost per prevented hospitalization: $52,416  

Sotrovimab

Sotrovimab has a similar success rate to Paxlovid but is far more expensive. The drug was approved for Canada in July 2021.

• Prevented hospitalizations: One of out every 25 patients
• Cost per prevented hospitalization: $52,500 

Casirivimab-Imdevimab / Bamlanivimab-Etesevimab

The combination of antibodies casirivimab and imdevimab, as well as the combination of bamlanivimab and etesevimab, are the most expensive treatments on the list and produced the same results in the study.

• Prevented hospitalizations: One of out every 29 patients
• Cost per prevented hospitalization: $60,900

Health Canada okayed the use of casirivimab-imdevimab in June 2021, although the drug is not an effective treatment against the Omicron variant, according to its own manufacturer. 

The use of bamlanivimab on its own was approved in Canada in November 2020, but combination of bamlanivimab and etesevimab has yet to be given the thumbs up.  

Molnupiravir 

Although not yet approved, the medication has been under review by Health Canada since August. 

• Prevented hospitalizations: One out of every 50 patients
• Cost per prevented hospitalization: $35,000 

 

EASING THE STRAIN

As Omicron surges across the province and hospitals overflow, drugs such as Paxlovid are looked to as a potential means of easing the burden.

The study authors say that to “prioritize deployment of therapies and capacity building,” health authorities are faced with important decisions regarding which treatments to implement.

“There is an ongoing need to identify effective treatments that can be administered early in the disease to prevent COVID-19 hospitalization and death and to make them available and accessible in all regions,” the study reads.

Quebec is set to receive 6,300 Paxlovid treatments in the near future, although Health Minister Christian Due points out that vaccination is still the province’s “best weapon.”

The province is expected to receive an additional 19,000 treatments in April.