Analisis Biaya dan Luaran Klinik Terapi Remdesivir dibandingkan Favipiravir pada COVID-19 Derajat Sedang: Perspektif Provider
Laduna Aniq(1), Tri Murti Andayani(2*), Dwi Endarti(3)
(1) Magister Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(2) Departemen Farmakologi dan Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(3) Departemen Farmakologi dan Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(*) Corresponding Author
Abstract
The COVID-19 pandemic cases affect health and the economy and have become a burden for the global community. Effective and specific antiviral for COVID-19 is still controversial and has yet to be found. Antiviral use is the main mitigation strategy that tends to be more cost-effective but varies in effectiveness and cost depending on various factors. This study aims to evaluate the effectiveness, safety, and cost of antiviral therapy in moderate COVID-19. This observational-analytic study used a retrospective cohort design. Subjects were hospitalized patients with moderate COVID-19 who received antivirals in July-October 2021 and January-March 2022. Therapy effectiveness was measured by lowered NLR (Neutrophil-to-Lymphocyte Ratio) to a normal level and length of stay (LOS). Drug safety includes adverse drug events. The cost of therapy was calculated based on the hospital’s perspective (provider), using direct medical costs. A total of 170 patients were divided into two groups (94 patients remdesivir and 76 patients favipiravir). In this arm, there were 45 patients with lowered NLR (21 patients reached the target and 24 patients did not). The effectiveness of favipiravir and remdesivir was 70.6% and 32.1%. Remdesivir may lower NLR (2.92) versus favipiravir (1.55). Favipiravir had a shorter LOS than remdesivir (8 vs 9 days). Adverse drug events observed in remdesivir were nausea (47.9%) and abdominal pain (22.3%), while in favipiravir nausea (53.9%) and vomiting (22.4%). The average total cost of remdesivir is higher than favipiravir (IDR 19,772,985 vs IDR 13,819,727). Favipiravir has higher efficacy and a shorter LOS with a lower average total cost than remdesivir.
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- Burhan E, Susanto AD, Nasution SA, et al. Pedoman Tatalaksana COVID-19 Edisi 4, Jakarta. Published online 2022:176.
- Damayanti H, Sajinadiyasa IGK, Risni HW, Sauriasari R. The Effectiveness and Safety of Favipiravir in COVID-19 Hospitalized Patients at Tertiary Referral Hospital, Bali, Indonesia. Kesmas: National Public Health Journal. 2021;16(4). doi:10.21109/kesmas.v16i4.5433
- Sheinson D, Dang J, Shah A, Meng Y, Elsea D, Kowal S. A Cost-Effectiveness Framework for COVID-19 Treatments for Hospitalized Patients in the United States. Adv Ther. 2021;38(4):1811-1831. doi:10.1007/s12325-021-01654-5
- Alkhatip AAAMM, Kamel MG, Hamza MK, et al. The diagnostic and prognostic role of neutrophil-to-lymphocyte ratio in COVID-19: a systematic review and meta-analysis. Expert Review of Molecular Diagnostics. 2021;21(5):505-514. doi:10.1080/14737159.2021.1915773
- Selanno Y, Widaningsih Y, Esa T, Arif M. Analysis of Neutrophil Lymphocyte Ratio and Absolute Lymphocyte Count as Predictors of Severity of COVID-19 Patients. Indonesian J Clin Pathol Med Lab. 2021;27(2):184-189. doi:10.24293/ijcpml.v27i2.1738
- fırat asuman akkaya. Biochemical Markers and NLR Levels in Covid-19 Infection: In Cases With Severe Pulmonary Involvement According to CT Score. Int J Med Biochem. Published online 2022. doi:10.14744/ijmb.2022.14890
- Han Q, Wen X, Wang L, et al. Role of hematological parameters in the diagnosis of influenza virus infection in patients with respiratory tract infection symptoms. J Clin Lab Anal. 2020;34(5). doi:10.1002/jcla.23191
- Song CY, Xu J, He JQ, Lu YQ. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. Published online March 8, 2020:2020.03.05.20031906. doi:10.1101/2020.03.05.20031906
- Kerboua KE. NLR: A Cost-effective Nomogram to Guide Therapeutic Interventions in COVID-19. Immunological Investigations. 2021;50(1):92-100. doi:10.1080/08820139.2020.1773850
- Mousavi-Nasab SD, Mardani R, Azadani HN, Sabeti S, Darazam IA, Ahmadi N. Neutrophil to lymphocyte ratio and C-reactive protein level as prognostic markers in mild versus severe COVID-19 patients. :6.
- Dawoud DM, Soliman KY. Cost-Effectiveness of Antiviral Treatments for Pandemics and Outbreaks of Respiratory Illnesses, Including COVID-19: A Systematic Review of Published Economic Evaluations. Value in Health. 2020;23(11):1409-1422. doi:10.1016/j.jval.2020.07.002
- Yavuz SŞ, Çeli̇Kyurt İK. An update of anti-viral treatment of COVID-19. Turk J Med Sci.:19.
- Arnold RJG, ed. Pharmacoeconomics: From Theory to Practice. Second edition. CRC Press; 2020.
- Andayani TM. Farmakoekonomi Prinsip Dan Metodologi. Bursa Ilmu; 2013.
- Rezapour A, Behroozi Z, Nasirzadeh M, et al. Cost-effectiveness of remdesivir for the treatment of hospitalized patients with COVID-19: a systematic review. Infect Dis Poverty. 2023;12(1):39. doi:10.1186/s40249-023-01092-1
- Oksuz E, Malhan S, Gonen MS, et al. Cost-Effectiveness Analysis of Remdesivir Treatment in COVID-19 Patients Requiring Low-Flow Oxygen Therapy: Payer Perspective in Turkey. Adv Ther. 2021;38(9):4935-4948. doi:10.1007/s12325-021-01874-9
- Jo Y, Jamieson L, Edoka I, et al. Cost-effectiveness of Remdesivir and Dexamethasone for COVID-19 Treatment in South Africa. Open Forum Infectious Diseases. 2021;8(3):ofab040. doi:10.1093/ofid/ofab040
- Rafia R, Martyn-St James M, Harnan S, Metry A, Hamilton J, Wailoo A. A Cost-Effectiveness Analysis of Remdesivir for the Treatment of Hospitalized Patients With COVID-19 in England and Wales. Value in Health. 2022;25(5):761-769. doi:10.1016/j.jval.2021.12.015
- Kelton K, Klein T, Murphy D, et al. Cost-Effectiveness of Combination of Baricitinib and Remdesivir in Hospitalized Patients with COVID-19 in the United States: A Modelling Study. Adv Ther. 2022;39(1):562-582. doi:10.1007/s12325-021-01982-6
- Fathurrahman MH, Simanjutak N, Sopiah NS. Analisis Efektivitas Biaya Penggunaan Obat Pada Pasien Rawat Inap Penyakit COVID-19 Kategori Suspek Non-Comorbid Dengan Terapi Obat Kombinasi Antivirus dan Antibiotik di Salah Satu Rumah Sakit Kota Bandung Periode Juli – Desember 2021. Pharma Xplore Jurnal Sains dan Ilmu Farmasi. 2023;Vol. 8 Nomor 1.
- Rahmandani A, Sarnianto P, Anggriani Y, Dermawan Purba F. Analisis Efektivitas Biaya Penggunaan Obat Antivirus Oseltamivir dan Favipiravir pada Pasien Covid-19 Derajat Sedang di Rumah Sakit Sentra Medika Cisalak Depok. Maj Farmasetika. 2021;6:133. doi:10.24198/mfarmasetika.v6i0.36667
- Yusransyah Y, Udin B, Mursyid A, Mardiyanto Y, Uli ES, Suryana N. Analisis Efektivitas Biaya pada Pasien Covid-19 yang Menggunakan Terapi Oksigen dengan dan Tanpa Diberikan Remdesivir di RSUD Kabupaten Tangerang. Jurnal Farmasi Indonesia. 2022;Vol.14 Nomor 1. doi:doi.org/10.35617/jfionline.v14i1.75
- Grundeis F, Ansems K, Dahms K, et al. Remdesivir for the treatment of COVID-19. Cochrane Haematology Group, ed. Cochrane Database of Systematic Reviews. 2023;2023(1). doi:10.1002/14651858.CD014962.pub2
- Aung KZL, Yılmaz R, Güngördü E, Aşar S, Tekdos Şeker Y. Does Favipiravir Reduce Mortality in Patients with COVID-19 ARDS and Severe Pneumonia? tybd. 2021;19(1):102-109. doi:10.4274/tybd.galenos.2021.04706
- Munir MA, Kuganda H, Basry A. The Efficacy and Safety of Antivirus Drugs for COVID-19: A Systematic Review. Systematic Reviews in Pharmacy. 2020;11(7):5.
- Kementerian Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/413/2020 Tentang Pedoman Pencegahan Dan Pengendalian Coronavirus Disease 2019 (COVID-19).; 2020.
- Menteri Kesehatan RI. Peraturan Menteri Kesehatan Republik Indonesia Nomor 23 Tahun 2023 Tentang Pedoman Penanggulangan Corona Virus Disease 2019 (COVID-19). Published online 2023.
- Lemeshow S, World Health Organization, eds. Adequacy of Sample Size in Health Studies. Published on behalf of the World Health Organization by Wiley ; Distributed in the U.S.A., Canada, and Japan by Liss; 1990.
- Cai Q, Yang M, Liu D, et al. Experimental Treatment with Favipiravir for COVID-19: An Open-Label Control Study. Engineering. 2020;6(10):1192-1198. doi:10.1016/j.eng.2020.03.007
- Dahlan MS. Analisis Multivariat Regresi Logistik. 2nd ed. PT Epidemiologi Indonesia; 2019.
- Sastroasmoro S, Sofyan I. Dasar-Dasar Metodologi Penelitian Klinis. 5th ed. Sagung Seto; 2014.
- Rauf A, Abu-Izneid T, Olatunde A, et al. COVID-19 Pandemic: Epidemiology, Etiology, Conventional and Non-Conventional Therapies. IJERPH. 2020;17(21):8155. doi:10.3390/ijerph17218155
- Ariza D, Kesrianti AM, Ruslan TA. Neutrophil Lymphocyte Ratio (NLR) in COVID-19 Patients Receiving Convalescent Plasma Therapy. IJMLST. 2022;4(2):139-147. doi:10.33086/ijmlst.v4i2.2460
- Adane T, Melku M, Worku YB, et al. The Association between Neutrophil-to-Lymphocyte Ratio and Glycemic Control in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Diabetes Res. 2023;2023:3117396. doi:10.1155/2023/3117396
- He F, Deng Y, Li W. Coronavirus disease 2019: What we know?, J Med Virol. 2020;92:719-725. DOI: 10.1002/jmv.25766.
- Nile SH, Nile A, Qiu J, Li L, Jia X, Kai G. COVID-19: Pathogenesis, cytokine storm and therapeutic potential of interferons. Cytokine & Growth Factor Reviews. 2020;53:66-70. doi:10.1016/j.cytogfr.2020.05.002
- Zaki N, Alashwal H, Ibrahim S. Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: A systematic review. Diabetes Metab Syndr. 2020;14(5):1133-1142. doi:10.1016/j.dsx.2020.07.005
- Zhang J, Wu J, Sun X, et al. Association of hypertension with the severity and fatality of SARS-CoV-2 infection: A meta-analysis. Epidemiol Infect. 2020;148:e106. doi:10.1017/S095026882000117X
- Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA. Published online April 13, 2020. doi:10.1001/jama.2020.6019
- WHO. Therapeutics and COVID-19: Living Guideline. World Health Organization; 2022. WHO reference number: WHO/2019-nCoV/therapeutics/2022.2
- The RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704. doi:10.1056/NEJMoa2021436
- Joshi S, Vora A, Venugopal K, et al. Real-World Experience with Favipiravir for the Treatment of Mild-to-Moderate COVID-19 in India. POR. 2022;Volume 13:33-41. doi:10.2147/POR.S364066
- Adhikari P, Koirala J, Shrestha A, et al. Efficacy of Favipiravir in treatment of mild & moderate COVID-19 infection in Nepal: a multi-center, randomized, open-labelled, phase III clinical trial. International Journal of Infectious Diseases. 2022;116:S45-S46. doi:10.1016/j.ijid.2021.12.109
- Krongsut S, Naraphong W, Thongsuk P, Tantirat P. Comparison of The Effectiveness of Remdesivir Versus Favipiravir on Clinical Improvement And Mortality Among Patients with COVID-19 Pneumonia: A Retrospective Single-Center Study. Journal of Southeast Asian Medical Research. 2023;7:e0151-e0151. doi:10.55374/jseamed.v7.151
- Aryati. Aspek Laboratorium COVID-19: pemeriksaan serologi dan PCR. Presented at: Sysmex Webinar Series COVID-19; May 21, 2020.
- Syahrini H, Fadjari TH, Dalimoenthe NZ. Neutrophil-Lymphocyte Ratio (NLR) and Lymphocyte-Monocyte Ratio (LMR) as Covid-19 Screening Parameters. IJMLST. 2022;4(1):10-23. doi:10.33086/ijmlst.v4i1.2281
- Yang AP, Liu J ping, Tao W qiang, Li H ming. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. International Immunopharmacology. 2020;84:106504. doi:10.1016/j.intimp.2020.106504
- Rotty LWA, Andrea D, Fujiyanto F, et al. Hubungan Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio, dan Ferritin dengan Pemberian Remdesivir pada Pasien Covid-19 dengan Peningkatan Transaminase. e-CliniC. 2023;11(3):322-329. doi:10.35790/ecl.v11i3.46845
- Qadir HK, Jaff HN, Saber HK. Efficacy of Favipiravir in the Treatment of Mild to Moderate COVID-19 Patients in Erbil: A Controlled Clinical Trial. 2022;(1).
- Liu J, Liu Y, Xiang P, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020;18(1):206. doi:10.1186/s12967-020-02374-0
DOI: https://doi.org/10.22146/jmpf.87168
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