Mugwagwa T, Marcano Belisario J, Hartley L, Phan NTN. Nirmatrelvir/ritonavir treatment for COVID-19: an economic value systematic literature review. J Med Econ. 2025 Nov 6;28(1):1933-54. doi: 10.1080/13696998.2025.2579407

AIMS: Nirmatrelvir/ritonavir (NMV/r)* is an antiviral drug used to treat mild-to-moderate coronavirus disease 2019 (COVID-19) in patients at high risk of progression to severe COVID-19. We conducted an economic systematic literature review to assess key parameters, structures, and outcomes of existing models and analyses of the economic value of NMV/r treatment.

METHODS: A systematic search of Embase, MEDLINE, and MEDLINE In-Process, as well as bibliographies of systematic reviews and conference and health technology assessment websites, identified relevant articles published between 2022 and 2024. A quality assessment was conducted for each economic evaluation using the Drummond checklist.

RESULTS: Of the 22 included economic evaluations, most were cost-utility analyses (n = 10) and cost-effectiveness analyses (n = 9). Most used a short-term decision tree with a long-term Markov model (n = 5), with time horizons between 28 days to a lifetime, and were from a healthcare system perspective (n = 7). Most conducted scenario analyses (n = 15) and/or sensitivity analyses (n = 18), and many based treatment effectiveness estimates on the Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients (EPIC-HR) randomized controlled trial (n = 7). Overall, NMV/r showed economic value across different wiliness-to-pay thresholds when compared with standard of care or best supportive care, and all economic evaluations were high or moderate quality.

LIMITATIONS: Most included economic evaluations were from high-income countries and all were written in English and may not be generalizable to low-income countries or healthcare systems.