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Volume 30, Number 2—February 2024
Research

Public Health Impact of Paxlovid as Treatment for COVID-19, United States

Yuan Bai1, Zhanwei Du1, Lin Wang1, Eric H.Y. Lau1, Isaac Chun-Hai Fung, Petter Holme, Benjamin J. Cowling, Alison P. Galvani, Robert M. Krug, and Lauren Ancel MeyersComments to Author 
Author affiliations: The University of Hong Kong, Hong Kong (Y. Bai, Z. Du, E.H.Y. Lau, B.J. Cowling); Hong Kong Science and Technology Park, Hong Kong, China (Y. Bai, Z. Du, E.H.Y. Lau, B.J. Cowling); University of Cambridge, Cambridge, UK (L. Wang); Deakin University, Burwood, Victoria, Australia (E.H.Y. Lau); Georgia Southern University, Statesboro, Georgia, USA (I. C.-H. Fung); Aalto University, Espoo, Finland (P. Holme); Kobe University, Kobe, Japan (P. Holme); Yale School of Public Health, New Haven, Connecticut, USA (A.P. Galvani); University of Texas at Austin, Austin, Texas, USA (R.M. Krug, L.A. Meyers); Santa Fe Institute, Santa Fe, New Mexico, USA (L.A. Meyers)

Main Article

Figure 3

Projected health and economic impacts of a large-scale campaign using Paxlovid to treat COVID-19 over 300 days in the United States, across a range of transmission and treatment scenarios. Points and error bars correspond to means and 95% CI in number of infections in millions (A), number of deaths in millions (B), net monetary benefit in billions USD assuming a treatment course cost of US $530 and willingness to pay per year of life lost averted of US $100,000 (C), and number of courses of Paxlovid administered in millions (D). Each graph provides results for 3 Rt and 5 different treatment scenarios: 0% (blue), 20% (red), 50% (green), 80% (purple), or 100% (orange) of symptomatic cases started a 5-day course of Paxlovid within 3 days of symptom onset. Distributions are based on 100 stochastic simulations for each scenario. The results are scaled assuming a US population of 328.2 million (21). Rt, effective reproduction number; USD, US dollars.

Figure 3. Projected health and economic impacts of a large-scale campaign using Paxlovid to treat COVID-19 over 300 days in the United States, across a range of transmission and treatment scenarios. Points and error bars correspond to means and 95% CI in number of infections in millions (A), number of deaths in millions (B), net monetary benefit in billions USD assuming a treatment course cost of US $530 and willingness to pay per year of life lost averted of US $100,000 (C), and number of courses of Paxlovid administered in millions (D). Each graph provides results for 3 Rt and 5 different treatment scenarios: 0% (blue), 20% (red), 50% (green), 80% (purple), or 100% (orange) of symptomatic cases started a 5-day course of Paxlovid within 3 days of symptom onset. Distributions are based on 100 stochastic simulations for each scenario. The results are scaled assuming a US population of 328.2 million (21). Rt, effective reproduction number; USD, US dollars.

Main Article

References
  1. Dadonaite  B. Antiretroviral therapy has saved millions of lives from AIDS and could save more [cited 2021 Feb 22]. https://ourworldindata.org/art-lives-saved
  2. Suda  KJ, Hunkler  RJ, Matusiak  LM, Schumock  GT. Influenza antiviral expenditures and outpatient prescriptions in the United States, 2003–2012. Pharmacotherapy. 2015;35:991–7. DOIPubMedGoogle Scholar
  3. Dobson  J, Whitley  RJ, Pocock  S, Monto  AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015;385:1729–37. DOIPubMedGoogle Scholar
  4. Du  Z, Nugent  C, Galvani  AP, Krug  RM, Meyers  LA. Modeling mitigation of influenza epidemics by baloxavir. Nat Commun. 2020;11:2750. DOIPubMedGoogle Scholar
  5. Wahl  A, Gralinski  LE, Johnson  CE, Yao  W, Kovarova  M, Dinnon  KH III, et al. SARS-CoV-2 infection is effectively treated and prevented by EIDD-2801. Nature. 2021;591:451–7. DOIPubMedGoogle Scholar
  6. Shah  MM, Joyce  B, Plumb  ID, Sahakian  S, Feldstein  LR, Barkley  E, et al. Paxlovid associated with decreased hospitalization rate among adults with COVID-19—United States, April–September 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1531–7. DOIPubMedGoogle Scholar
  7. Pfizer. Pfizer shares in vitro efficacy of novel COVID-19 oral treatment against Omicron variant [cited 2022 Mar 21]. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-shares-vitro-efficacy-novel-covid-19-oral-treatment
  8. Pfizer. Pfizer to provide U.S. government with an additional 10 million treatment courses of its oral therapy to help combat COVID-19 [cited 2022 Mar 25]. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-provide-us-government-additional-10-million
  9. Jenner  AL, Aogo  RA, Alfonso  S, Crowe  V, Deng  X, Smith  AP, et al. COVID-19 virtual patient cohort suggests immune mechanisms driving disease outcomes. PLoS Pathog. 2021;17:e1009753. DOIPubMedGoogle Scholar
  10. Kim  KS, Ejima  K, Iwanami  S, Fujita  Y, Ohashi  H, Koizumi  Y, et al. A quantitative model used to compare within-host SARS-CoV-2, MERS-CoV, and SARS-CoV dynamics provides insights into the pathogenesis and treatment of SARS-CoV-2. PLoS Biol. 2021;19:e3001128. DOIPubMedGoogle Scholar
  11. Hammond  J, Leister-Tebbe  H, Gardner  A, Abreu  P, Bao  W, Wisemandle  W, et al.; EPIC-HR Investigators. EPIC-HR Investigators. Oral nirmatrelvir for high-risk, nonhospitalized adults with Covid-19. N Engl J Med. 2022;386:1397–408. DOIPubMedGoogle Scholar
  12. Handel  A, Rohani  P. Crossing the scale from within-host infection dynamics to between-host transmission fitness: a discussion of current assumptions and knowledge. Philos Trans R Soc Lond B Biol Sci. 2015;370:20140302. DOIPubMedGoogle Scholar
  13. Néant  N, Lingas  G, Le Hingrat  Q, Ghosn  J, Engelmann  I, Lepiller  Q, et al.; French COVID Cohort Investigators and French Cohort Study groups. Modeling SARS-CoV-2 viral kinetics and association with mortality in hospitalized patients from the French COVID cohort. Proc Natl Acad Sci U S A. 2021;118:e2017962118. DOIPubMedGoogle Scholar
  14. Wölfel  R, Corman  VM, Guggemos  W, Seilmaier  M, Zange  S, Müller  MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020;581:465–9. DOIPubMedGoogle Scholar
  15. Du  Z, Pandey  A, Bai  Y, Fitzpatrick  MC, Chinazzi  M, Pastore Y Piontti  A, et al. Comparative cost-effectiveness of SARS-CoV-2 testing strategies in the USA: a modelling study. Lancet Public Health. 2021;6:e184–91. DOIPubMedGoogle Scholar
  16. U.S. Federal Highway Administration. 2017 national household travel survey [cited 2020 Jun 16]. https://nhts.ornl.gov/downloads
  17. Neumann  PJ, Cohen  JT, Weinstein  MC. Updating cost-effectiveness—the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014;371:796–7. DOIPubMedGoogle Scholar
  18. Czuppon  P, Débarre  F, Gonçalves  A, Tenaillon  O, Perelson  AS, Guedj  J, et al. Success of prophylactic antiviral therapy for SARS-CoV-2: Predicted critical efficacies and impact of different drug-specific mechanisms of action. PLOS Comput Biol. 2021;17:e1008752. DOIPubMedGoogle Scholar
  19. Traynard  P, Ayral  G, Twarogowska  M, Chauvin  J. Efficient pharmacokinetic modeling workflow with the MonolixSuite: a case study of remifentanil. CPT Pharmacometrics Syst Pharmacol. 2020;9:198–210. DOIPubMedGoogle Scholar
  20. Lavielle  M, Mentré  F. Estimation of population pharmacokinetic parameters of saquinavir in HIV patients with the MONOLIX software. J Pharmacokinet Pharmacodyn. 2007;34:229–49. DOIPubMedGoogle Scholar
  21. US Census Bureau. National population by characteristics: 2010–2019 [cited 2020 Oct 1]. https://www.census.gov/data/tables/time-series/demo/popest/2010s-national-detail.html
  22. Robbins  R, Zimmer  C. FDA clears Pfizer’s Covid pill for high-risk patients 12 and older. 2021 Dec 22 [cited 2022 Apr 29]. https://www.nytimes.com/2021/12/22/health/pfizer-covid-pill-fda-paxlovid.html
  23. TIME. China’s approval of Pfizer pill opens door to ending COVID Zero. 2022 Feb 14 [cited 2023 Jan 21]. https://time.com/6147924/china-pfizer-covid-19-pill
  24. COVID.gov. Find COVID-19 guidance for your community [cited 2022 Apr 29]. https://www.covid.gov
  25. Joshi  AU, Lewiss  RE, Aini  M, Babula  B, Henwood  PC. Solving community SARS-CoV-2 testing with telehealth: development and implementation for screening, evaluation and testing. JMIR Mhealth Uhealth. 2020;8:e20419. DOIPubMedGoogle Scholar
  26. Centers for Disease Control and Prevention. New COVID-19 test to treat initiative and locator tool [cited 2022 Apr 6]. https://emergency.cdc.gov/newsletters/coca/040422.htm
  27. Huang  F, Liu  H. The impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization in China. Health Econ. 2023;32:620–38. DOIPubMedGoogle Scholar
  28. National Health Commission of the People’s Republic of China. China’s internet health services gathering steam amid COVID-19 [cited 2022 Dec 7]. http://en.nhc.gov.cn/2021-08/24/c_85005.htm
  29. He  D, Gu  Y, Shi  Y, Wang  M, Lou  Z, Jin  C. COVID-19 in China: the role and activities of Internet-based healthcare platforms. Glob Health Med. 2020;2:89–95. DOIPubMedGoogle Scholar
  30. China Internet Network Information Center. 48th statistical report on internet development in China [cited 2021 Nov 19]. https://www.cnnic.com.cn/IDR/ReportDownloads/202111/P020211119394556095096.pdf
  31. Vegvari  C, Hadjichrysanthou  C, Cauët  E, Lawrence  E, Cori  A, de Wolf  F, et al. How can viral dynamics models inform endpoint measures in clinical trials of therapies for acute viral infections? PLoS One. 2016;11:e0158237. DOIPubMedGoogle Scholar
  32. Iketani  S, Mohri  H, Culbertson  B, Hong  SJ, Duan  Y, Luck  MI, et al. Multiple pathways for SARS-CoV-2 resistance to nirmatrelvir. Nature. 2023;613:558–64. DOIPubMedGoogle Scholar
  33. Callaway  E. How months-long COVID infections could seed dangerous new variants. Nature. 2022;606:452–5. DOIPubMedGoogle Scholar
  34. Herxheimer  A. Relationships between the pharmaceutical industry and patients’ organisations. BMJ. 2003;326:1208–10. DOIPubMedGoogle Scholar
  35. Biggerstaff  M, Jhung  MA, Reed  C, Fry  AM, Balluz  L, Finelli  L. Influenza-like illness, the time to seek healthcare, and influenza antiviral receipt during the 2010-2011 influenza season-United States. J Infect Dis. 2014;210:535–44. DOIPubMedGoogle Scholar

Main Article

1These authors contributed equally to this article.

Page created: December 21, 2023
Page updated: January 24, 2024
Page reviewed: January 24, 2024
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