Evidence map›Paper›PMID 33732750›Full record

ArticleOpen forum infectious diseases2021

Cost-effectiveness of Remdesivir and Dexamethasone for COVID-19 Treatment in South Africa.

Youngji Jo, Lise Jamieson, Ijeoma Edoka, Lawrence Long, Sheetal Silal, Juliet R C Pulliam, Harry Moultrie, Ian Sanne, Gesine Meyer-Rath, Brooke E Nichols

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Open forum infectious diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 7 pooled it
6.2field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 7 syntheses or guidelines pooled it, 44 citations in OpenAlex.

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  7. Diagnostics and Treatments of COVID-19: A Living Systematic Review of Economic Evaluations.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 7 institutions in 3 countries.

Youngji JoSection of Infectious Disease, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA.
Lise JamiesonHealth Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Ijeoma EdokaSAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Lawrence LongHealth Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Sheetal SilalModelling and Simulation Hub, Africa, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa.
Juliet R C PulliamSouth African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
Harry MoultrieDivision of the National Health Laboratory Service, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa.
Ian SanneHealth Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Gesine Meyer-RathHealth Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Brooke E NicholsHealth Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.ORCID https://orcid.org/0000-0003-4682-4999
Boston University · USUniversity of the Witwatersrand · ZABoston Medical Center · USNational Health Laboratory Service · ZASouth African Medical Research Council · ZAStellenbosch University · ZAUniversity of Cape Town · ZA

Funding

BU Clinical HIV/AIDS Research Training Program (BU-CHART)T32AI052074 · NIAID · BOSTON UNIVERSITY MEDICAL CAMPUS · PI Benjamin P. Linas · 2003 to 2026
$6.7M
Using behavioral economics to improve the uptake of and persistence on pre-exposure prophylaxis in men who have sex with men to prevent HIV infectionK01MH119923 · NIMH · BOSTON UNIVERSITY MEDICAL CAMPUS · PI LONG, LAWRENCE CAMDON · 2020 to 2024
$865k
NIAID NIH HHS T32 AI052074NIMH NIH HHS K01 MH119923Wellcome Trust
6 · The paper itself

Abstract

backgroundDexamethasone and remdesivir have the potential to reduce coronavirus disease 2019 (COVID)-related mortality or recovery time, but their cost-effectiveness in countries with limited intensive care resources is unknown.

methodsWe projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed the cost-effectiveness of (1) administration of dexamethasone to ventilated patients and remdesivir to nonventilated patients, (2) dexamethasone alone to both nonventilated and ventilated patients, (3) remdesivir to nonventilated patients only, and (4) dexamethasone to ventilated patients only, all relative to a scenario of standard care. We estimated costs from the health care system perspective in 2020 US dollars, deaths averted, and the incremental cost-effectiveness ratios of each scenario.

resultsRemdesivir for nonventilated patients and dexamethasone for ventilated patients was estimated to result in 408 (uncertainty range, 229-1891) deaths averted (assuming no efficacy [uncertainty range, 0%-70%] of remdesivir) compared with standard care and to save $15 million. This result was driven by the efficacy of dexamethasone and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone for nonventilated and ventilated patients requires an additional $159 000 and averts 689 [uncertainty range, 330-1118] deaths, resulting in $231 per death averted, relative to standard care.

conclusionsThe use of remdesivir for nonventilated patients and dexamethasone for ventilated patients is likely to be cost-saving compared with standard care by reducing ICU days. Further efforts to improve recovery time with remdesivir and dexamethasone in ICUs could save lives and costs in South Africa.

Indexed as

cost-effectivenessCOVID-19dexamethasonehospital bed capacityintensive caremathematical modelremdesivirSARS-CoV-2

Identifiers

PMID33732750
PMCPMC7928624
OpenAlexW3128171059

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.