• May Ee Png, Victoria Harris, Jenna Grabey, Nigel D Hart, Bhautesh D Jani, Daniel Butler, Andrew Carson-Stevens, Maria Coates, Lucy Cureton, Melissa Dobson, Jienchi Dorward, Philip Evans, Nick Francis, Oghenekome A Gbinigie, Gail Hayward, Jane Holmes, Kerenza Hood, Saye Khoo, Haroon Ahmed, Mark Lown, Micheal McKenna, Sam Mort, Jonathan S Nguyen-Van-Tam, Najib M Rahman, Duncan B Richards, Nicholas Pb Thomas, Oliver van Hecke, Richard Hobbs, Paul Little, Ly-Mee Yu, Christopher C Butler, Stavros Petrou, and PANORAMIC Trial Collaborators.
• Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
• Br J Gen Pract. 2024 Aug 1; 74 (745): e570e579e570-e579.

BackgroundThe cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations.AimTo evaluate the cost-effectiveness of molnupiravir relative to usual care alone among mainly vaccinated community-based people at higher risk of severe outcomes from COVID-19 over 6 months.Design And SettingAn economic evaluation of the PANORAMIC trial in the UK.MethodA cost-utility analysis that adopted a UK NHS and personal social services perspective and a 6-month time horizon was performed using PANORAMIC trial data. Cost-effectiveness was expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity and subgroup analyses assessed the impacts of uncertainty and heterogeneity. Threshold analysis explored the price for molnupiravir consistent with likely reimbursement.ResultsIn the base-case analysis, molnupiravir had higher mean costs of £449 (95% confidence interval [CI] = 445 to 453) and higher mean QALYs of 0.0055 (95% CI = 0.0044 to 0.0067) than usual care (mean incremental cost per QALY of £81 190). Sensitivity and subgroup analyses showed similar results, except for those aged ≥75 years, with a 55% probability of being cost-effective at a £30 000 per QALY threshold. Molnupiravir would have to be priced around £147 per course to be cost-effective at a £15 000 per QALY threshold.ConclusionAt the current cost of £513 per course, molnupiravir is unlikely to be cost-effective relative to usual care over a 6-month time horizon among mainly vaccinated patients with COVID-19 at increased risk of adverse outcomes, except those aged ≥75 years.© The Authors.

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