Summary of health economic evaluation framework (E-CATCO)
| Question | Is the use of remdesivir as compared with standard care without remdesivir cost-effective for the prevention of death and other clinically important outcomes (invasive mechanical ventilation) in adult, hospitalized patients with COVID-19 in the CATCO trial? |
| Perspective | Health care public payer (in-hospital costs) |
| Setting | Adult, hospitalized patients with COVID-19 (52 centres, 6 provinces in Canada: British Columbia, Alberta, Manitoba, Ontario, Quebec, Newfoundland and Labrador) |
| Comparators | Remdesivir group: Remdesivir 200 mg intravenous initially and 100 mg on days 1 up to 9 (or until discontinued by treatment team) plus usual care versus Usual care group: usual care without remdesivir |
| Time horizon | From participant randomization to hospital discharge or death (nonfixed time span) |
| Discount rate | No discounting (no long-term follow-up > 1 yr) |
| Clinical outcomes | In-hospital mortality, invasive mechanical ventilation |
| Costs | Direct medical costs associated with treatment and complications (ICU and ward hoteling costs, personnel, medications, laboratory and radiology, and procedures and surgeries) per jurisdiction Mean unit cost approach (across all jurisdictions) for missing unit costs per jurisdiction |
| Evaluation | Primary outcome: ICERs per in-hospital death averted Secondary outcomes: ICERs for other clinically important outcomes: incremental cost per invasive mechanical ventilation event averted |
| Currency (price date) | Canadian dollars (2020) |
| Uncertainty | Nonparametric bootstrapping to produce confidence intervals (probabilistic sensitivity analysis) Cost sampling from publicly available databases (6 jurisdictions) Sensitivity analyses to deal with structural and methodological uncertainty |
Note: CATCO = Canadian Treatments for COVID-19, E-CATCO = economic evaluation alongside CATCO, ICER = incremental cost-effectiveness ratio, ICU = intensive care unit.