Budget Impact of Adopting Nirmatrelvir-Ritonavir for Treating COVID-19 in a Large Integrated Healthcare System.

Bui DP, Hynes DM, Wong E, Vergun R, Yan L, Li Y, Rajeevan N, Berry K, Lin HM, Huang Y, Govier DJ, Aslan M, Ioannou G, Bajema KL. Budget Impact of Adopting Nirmatrelvir-Ritonavir for Treating COVID-19 in a Large Integrated Healthcare System. Open forum infectious diseases. 2025 Oct 1; 12(10):ofaf596, DOI: 10.1093/ofid/ofaf596.

Related HSR&D Project(s)

• C19 21-279 – COVID-19 Observational Research Collaboratory - Long-Term Outcomes (LTO) Study

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Abstract:

BACKGROUND: Understanding the budget impact of prescribing nirmatrelvir-ritonavir (NR) for COVID-19 can inform procurement and allocation strategies in large healthcare systems. METHODS: We assessed the budget impact of providing NR in the Veterans Health Administration (VHA) for all treatment-eligible Veterans (laboratory-confirmed COVID-19 illness from April 2022 through March 2023) and by clinical subgroups, including predicted hospitalization/death risk quartile. We used decision tree models that included 30-day emergency department (ED) visits, hospitalizations, and death to assess the budget impact of NR. Transition probabilities were derived from a target trial emulation of NR effectiveness in the same population. We priced NR at $1031/course and used cost accounting records to estimate ED ($1420), hospitalization ($22 419), and hospitalization with ICU ($59 918) costs. RESULTS: Among 138 261 treatment-eligible Veterans, 18% ( < i > n < /i > = 24 892) were prescribed NR. Treating all patients compared with treating none reduced healthcare costs by -$20 million (uncertainty bound [UB]: -70-0.23) but increased total budget costs by +$122 million (UB: 73-143) due to NR purchasing costs. Targeted treatment of patients in the highest risk quartile ( < i > n < /i > = 19 406) achieved healthcare cost savings of -$17 million (UB: -49 to -3) and a modest total budget increase (+$3 million, UB: -29-17). CONCLUSIONS: NR may reduce 30-day COVID-19 healthcare utilization costs, but the high cost of purchasing NR is likely to exceed those savings. Price reductions are necessary for NR to be a financially viable treatment for healthcare systems. Risk-informed allocation strategies can help maximize treatment benefits and minimize budget increases.