国立保健医療科学院 保健医療経済評価研究センター
Center for Outcomes Research and Economic
Evaluation for Health (C2H), National Institute of
Public Health (NIPH) | URL: http://c2h.niph.go.jp

April 4, 2023

[C2H2111] Summary of cost–effectivenessevaluation of remdesivir (Veklury®)
1. Indication
Coronavirus disease 2019 (COVID-19)
2. Price of the drug
Remdesivir has been reimbursed since August 2021 at JPY 63,342 (as of January2023). The price is calculated based on the Cost Calculation Method. This productis designated as an H1 cost–effectiveness evaluation item.
3. Scope of cost–effectiveness evaluation
The scope of evaluation agreed upon at the first session of the Expert Committeeof Cost–Effectiveness Evaluation (ECCEE) is described below. This product is used
to treat COVID-19. As the effectiveness of remdesivir for COVID-19 is not likely
to be homogeneous and depends on the severity as per the Clinical Managementof Patients with COVID-19 by the Ministry of Health, Labour and Welfare (MHLW),
the population was divided into three parts.
Adults with COVID-19 were categorized based on the severity*
as follows:(a) Moderate I(93% < SpO2 < 96%; shortness of breath and pneumonia
Populationfindings)(b) Moderate II(SpO2 ≤ 93%; oxygen administration required)(c) Severe(administration to ICU or mechanical ventilator required)1* The definition follows Clinical Management of Patients with
COVID-19 by the MHLW
Comparator(a)(b)(c): Standard of Care (SoC)

4. Evaluation of additional benefits
The manufacturer searched for randomized controlled trials (RCTs) and non-RCTs
and then performed meta-analysis without distinguishing between RCTs and nonRCTs. The manufacturer insisted on the additional benefits of remdesivir over
SoC in each population because the meta-analysis showed that remdesivir had
statistically significant effectiveness or a superior tendency in recovery(discharge) and mortality compared to SoC. However, the academic groupinsisted that only RCTs be used to evaluate the additional benefits. Moreover,they insisted that the final SOLIDARITY trial report by the WHO should beconsidered in the evaluation of additional benefits because they identified thefinal report in the review process owing to the difference in the article search
period. The results of the meta-analysis by the academic group are as below. The
third ECCEE session concluded that the results of the academic group were more
appropriate. Based on the discussion, remdesivir has additional benefits for
populations (a) and (b), but not for population (c).

Population(a) Moderate I(b) Moderate II(c) Severe

Endpoint

Hazard ratio(95% confidence interval)†

Recovery (Discharge)

1.05 (0.88 to 1.24)

Mortality

0.76 (0.48 to 1.22)

Recovery (Discharge)

1.15 (0.87 to 1.53)

Mortality

0.70 (0.39 to 1.23)

Recovery (Discharge)0.93 (0.76 to 1.14)

Mortality

1.13 (0.91 to 1.40)

Hazard ratios for recovery (discharge) greater than 1 and for mortality less than†

1, indicate that remdesivir is more effective than the comparator.
5. Results of the cost–effectiveness analysis
The manufacturer performed a cost–utility analysis for each population using
decision tree and Markov models. The manufacturer used the results of theevaluation of additional benefits in the analysis. The academic group re-analyzed
2

using the results from the meta-analysis based on RCTs only (including the finalSOLIDARITY trial report) for populations (a) and (b). For population (c), theacademic group performed the cost-minimization analysis, as remdesivir did notshow any additional benefits over SoC. The ECCEE accepted the following results.
Population

Comparator

ICER (JPY/QALY)(a) Moderate I

SoC

14,555,045(b) Moderate II

SoC

190,503(c) Severe

SoC

Cost increase3