Efficacy and safety of antiviral treatments for symptomatic COVID-19 outpatients: network meta-analysis and budget impact analysis
IntroductionRemdesivir (RDV) and nirmatrelvir/ritonavir (NRM/RTV) are two antiviral agents for treating outpatient adults with mild to moderate symptomatic COVID-19 at high risk of developing a severe disease. The review objectives are to compare the efficacy and safety of these antivirals based on...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2025.1537018/full |
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| author | Giacomo Berti Daniele Mengato Honoria Ocagli Gianmarco Chinellato Maria Mazzitelli Anna Maria Cattelan Ileana Baldi Francesca Venturini |
| author_facet | Giacomo Berti Daniele Mengato Honoria Ocagli Gianmarco Chinellato Maria Mazzitelli Anna Maria Cattelan Ileana Baldi Francesca Venturini |
| author_sort | Giacomo Berti |
| collection | DOAJ |
| description | IntroductionRemdesivir (RDV) and nirmatrelvir/ritonavir (NRM/RTV) are two antiviral agents for treating outpatient adults with mild to moderate symptomatic COVID-19 at high risk of developing a severe disease. The review objectives are to compare the efficacy and safety of these antivirals based on published RCT and real-world data, and to evaluate costs from a healthcare perspective.MethodsThis study provides a network meta-analysis of RDV and NRM/RTV for early treatment of COVID-19. The outcomes analysed were hospitalisation for any cause and serious adverse events. A cost-analysis was performed incorporating drug costs, administration, hospitalisations, and management of adverse events. A budget impact analysis was estimated for the University Hospital of Padua.ResultsOur results indicated that RDV showed a trend towards a lower risk of hospitalisation compared to NRM/RTV (RR 1.59, 95% CI: 0.60–4.20), though this was not statistically significant. For safety, NRM/RTV demonstrated a slightly lower risk of serious adverse events compared to RDV (RR 0.92, 95% CI: 0.31–2.74), but without statistical significance. A cost analysis showed that NRM/RTV could save €550,854.46 per 1,000 patients. Finally, a budget impact analysis based on data from the University Hospital of Padua estimated annual savings of €210,977.25 if all early treatments were administered with NRM/RTV instead of RDV.DiscussionThe comparison of the two antiviral therapies for the early treatment of COVID-19 did not yield statistically significant differences in the potential efficacy and safety to prevent hospitalisation or serious adverse events. However, the results of the cost-analysis showed a saving in favour of NRM/RTV. |
| format | Article |
| id | doaj-art-c156d0f151bd4095bed866a07b4b66c2 |
| institution | DOAJ |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-c156d0f151bd4095bed866a07b4b66c22025-08-20T03:10:25ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-04-011610.3389/fphar.2025.15370181537018Efficacy and safety of antiviral treatments for symptomatic COVID-19 outpatients: network meta-analysis and budget impact analysisGiacomo Berti0Daniele Mengato1Honoria Ocagli2Gianmarco Chinellato3Maria Mazzitelli4Anna Maria Cattelan5Ileana Baldi6Francesca Venturini7Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, ItalyHospital Pharmacy Unit, Hospital-University of Padua, Padova, ItalyUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, ItalyHospital Pharmacy Unit, Hospital-University of Padua, Padova, ItalyInfectious and Tropical Diseases Unit, Hospital-University of Padua, Padova, ItalyInfectious and Tropical Diseases Unit, Hospital-University of Padua, Padova, ItalyUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, ItalyHospital Pharmacy Unit, Hospital-University of Padua, Padova, ItalyIntroductionRemdesivir (RDV) and nirmatrelvir/ritonavir (NRM/RTV) are two antiviral agents for treating outpatient adults with mild to moderate symptomatic COVID-19 at high risk of developing a severe disease. The review objectives are to compare the efficacy and safety of these antivirals based on published RCT and real-world data, and to evaluate costs from a healthcare perspective.MethodsThis study provides a network meta-analysis of RDV and NRM/RTV for early treatment of COVID-19. The outcomes analysed were hospitalisation for any cause and serious adverse events. A cost-analysis was performed incorporating drug costs, administration, hospitalisations, and management of adverse events. A budget impact analysis was estimated for the University Hospital of Padua.ResultsOur results indicated that RDV showed a trend towards a lower risk of hospitalisation compared to NRM/RTV (RR 1.59, 95% CI: 0.60–4.20), though this was not statistically significant. For safety, NRM/RTV demonstrated a slightly lower risk of serious adverse events compared to RDV (RR 0.92, 95% CI: 0.31–2.74), but without statistical significance. A cost analysis showed that NRM/RTV could save €550,854.46 per 1,000 patients. Finally, a budget impact analysis based on data from the University Hospital of Padua estimated annual savings of €210,977.25 if all early treatments were administered with NRM/RTV instead of RDV.DiscussionThe comparison of the two antiviral therapies for the early treatment of COVID-19 did not yield statistically significant differences in the potential efficacy and safety to prevent hospitalisation or serious adverse events. However, the results of the cost-analysis showed a saving in favour of NRM/RTV.https://www.frontiersin.org/articles/10.3389/fphar.2025.1537018/fullCOVID-19remdesivirnirmatrelvir-ritonavirnetwork meta-analysisoutpatientcost-analysis |
| spellingShingle | Giacomo Berti Daniele Mengato Honoria Ocagli Gianmarco Chinellato Maria Mazzitelli Anna Maria Cattelan Ileana Baldi Francesca Venturini Efficacy and safety of antiviral treatments for symptomatic COVID-19 outpatients: network meta-analysis and budget impact analysis Frontiers in Pharmacology COVID-19 remdesivir nirmatrelvir-ritonavir network meta-analysis outpatient cost-analysis |
| title | Efficacy and safety of antiviral treatments for symptomatic COVID-19 outpatients: network meta-analysis and budget impact analysis |
| title_full | Efficacy and safety of antiviral treatments for symptomatic COVID-19 outpatients: network meta-analysis and budget impact analysis |
| title_fullStr | Efficacy and safety of antiviral treatments for symptomatic COVID-19 outpatients: network meta-analysis and budget impact analysis |
| title_full_unstemmed | Efficacy and safety of antiviral treatments for symptomatic COVID-19 outpatients: network meta-analysis and budget impact analysis |
| title_short | Efficacy and safety of antiviral treatments for symptomatic COVID-19 outpatients: network meta-analysis and budget impact analysis |
| title_sort | efficacy and safety of antiviral treatments for symptomatic covid 19 outpatients network meta analysis and budget impact analysis |
| topic | COVID-19 remdesivir nirmatrelvir-ritonavir network meta-analysis outpatient cost-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2025.1537018/full |
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