{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:04:28Z","timestamp":1790021068257,"version":"4.0.1"},"reference-count":45,"publisher":"The Journal of Health Economics and Outcomes Research","issue":"1","license":[{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["jheor.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Nirmatrelvir\/ritonavir (NMV\/r) and molnupiravir are oral antiviral drugs approved for the treatment of early symptomatic patients with mild to moderate COVID-19 at high risk of progression to severe disease in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study evaluated, from a Japanese payer perspective, the cost-effectiveness of NMV\/r compared with molnupiravir among patients with COVID-19.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cost-effectiveness model describes the COVID-19 disease history and the impact of antiviral treatment on short-term and long-term outcomes. Nirmatrelvir\/ritonavir was compared with molnupiravir, and in the scenario analysis NMV\/r was compared with standard of care over a lifetime horizon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>When compared with molnupiravir, NMV\/r showed higher quality-adjusted life years (QALYs) (15.752 vs 15.739) and higher total cost (\u00a56\u2009248\u2009014 vs \u00a56\u2009245\u2009829 [US $44\u2009136.86 vs $44\u2009121.42]). The incremental cost-effectiveness ratio was \u00a5164\u2009934 (US $1165.12) per QALY gained, which was lower than the willingness-to-pay (WTP) threshold in Japan (\u00a55\u2009000\u2009000\/QALY [US $35\u2009320.71\/QALY]). In the scenario analysis, the incremental cost-effectiveness ratio was \u00a53\u2009646\u2009821 (US $25\u2009761.66) per QALY gained. One-way sensitivity analysis and probabilistic sensitivity analysis showed that NMV\/r was cost-effective compared with molnupiravir and standard of care consistently. All results of one-way sensitivity analysis showed that the incremental cost-effectiveness ratios were below the WTP threshold in Japan. The result of the cost-effectiveness acceptability curve showed that the probability that the incremental cost-effectiveness ratio was below the WTP of \u00a55\u2009000\u2009000\/QALY (US $35\u2009320.71\/QALY) was 100.00%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"conclusion\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nirmatrelvir\/ritonavir is cost-effective compared with molnupiravir and standard of care from a Japanese payer perspective. This study provides evidence for the cost-effectiveness of NMV\/r for patients with COVID-19.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.36469\/001c.129067","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T14:25:51Z","timestamp":1740407151000},"update-policy":"https:\/\/doi.org\/10.36469\/00001","source":"Crossref","is-referenced-by-count":3,"title":["Cost-effectiveness Analysis of Nirmatrelvir\/Ritonavir Compared with Molnupiravir in Patients at High Risk for Progression to Severe COVID-19 in Japan"],"prefix":"10.36469","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3699-7231","authenticated-orcid":true,"given":"Akira","family":"Yuasa","sequence":"first","affiliation":[{"name":"Pfizer Japan Inc.","department":["Japan Access & Value"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Matsuda","sequence":"additional","affiliation":[{"name":"IQVIA Solutions Japan G.K","department":["Real World Evidence Solutions & HEOR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Fujii","sequence":"additional","affiliation":[{"name":"Pfizer R&D Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tendai","family":"Mugwagwa","sequence":"additional","affiliation":[{"name":"Pfizer Inc.","department":["Global Access & Value"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Kado","sequence":"additional","affiliation":[{"name":"IQVIA Solutions Japan G.K.","department":["Real World Evidence Solutions & HEOR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mizuki","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Pfizer R&D Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Murata","sequence":"additional","affiliation":[{"name":"Pfizer Japan Inc.","department":["Medical Affairs"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Gu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05dqf9946","id-type":"ROR","asserted-by":"publisher"}],"name":"Institute of Science Tokyo","department":["Department of Infectious Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"22273","published-online":{"date-parts":[[2025,2,24]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"publisher","first-page":"ofac637","DOI":"10.1093\/ofid\/ofac637","article-title":"Population-level strategies for nirmatrelvir\/ritonavir prescribing-a cost-effectiveness analysis","volume":"9","author":"A. 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