Are Pfizer Paxlovid and Merck Molnupiravir cost-effective?

Event:On April 17, 2022, Shenzhen No. 3 Hospital shared the clinical cases of antiviral treatment of new crown patients (Omicron), including Using Pfizeroral Covid-19 Small Molecule DrugsPaxlovid (Nimatevir/Ritonavir)A retrospective cohort study and Merck & Co.oral Covid-19 small molecules A randomized controlled study of the drugMolnupiravir(monaprevir). Source: Shenzhen Third Hospital New Crown Case Summary, organized by Zhongkang Capital Research Center

Shenzhen No. 3 HospitalPfizerPaxlovid(Nimatvir/Limited Tonavir) in the treatment of novel coronavirus OmicronRetrospective cohort studyThe results show:

1. The nucleic acid negative rate on the 10th day of the disease course: the drug intervention group was significantly higher than the control group, with a statistical difference (P=0.041<0.05) 2. The average time to turn negative: the drug intervention group was shorter than the control group by about 3 days; ), 19 cases (79.2%) for 11 days, and 23 cases (95.8%) for 2 weeks; 4. It has good safety and no obvious side effects.

Source: Shenzhen Third Hospital New Crown Case Summary, organized by Zhongkang Capital Research Center

span>The results of the randomized controlled study of Merck’s Molnupiravir (monaprevir) in the treatment of new coronavirus Omicron in Shenzhen Third Hospital show:

1 , 5-day negative conversion rate of viral nucleic acid: drug group 18.42% (14/76) VS control group 0; 2. 7-day negative conversion rate of viral nucleic acid: drug group 39.47% (30/76) VS The control group was 6.45% (2/31); 3, the median time to negative conversion (d): the drug group 8.56±0.36 vs the control group 10.48±0.45;

4. Antiviral treatment can significantly shorten the time for viral nucleic acid to turn negative, which will play an important role in preventing the crowding of medical resources during the epidemic.

Discussion1: For the currently prevalent and fast-spreading Omicron Mild patients, use Does Paxlovid or Molnupiravir treatment have high efficacy and economic value? Shenzhen Third Hospital used these two small samples to treat patients with mild disease (or those with high risk factors) of the new crown of Omicron. From the overall results Look, the research results of all common and mild patients (or those with high risk factors) are no cases of severe disease or death, the end point of the study used viral nucleic acid to turn negative . Although the negative conversion rate of the new crown small molecule drugs (Paxlovid or Molnupiravir) seems to be better, the average or median time to negative conversion is only 3 days compared to the control group (no new crown small molecule drug group), respectively. and 2 days difference. From the perspective of pharmacoeconomics, on the one hand, PfizerPaxlovidprice in China< /span>2300/box, according to the latest ninth edition of the new crown diagnosis and treatment plan guidelines, a course of treatment for 5 days, that is 1150 yuan / course of treatment; Molnupiraviris not approved in China, and public data is $700/course. On the other hand, Shenzhen Third Hospital’s small sample study results showed that the average and median time to negative conversion were similar. Large (2 days and 3 days), does it have a more important effect on reducing the run on medical resources during the epidemic? Source: Public data, compiled by Zhongkang Capital Research Center

Pfizer PaxlovidApproved pivotal Phase III clinical trial, both the primary endpoint (disease remission) and the secondary endpoint (viral load) achieved very significant effects (P<0.001) , and in vitro dataconfirmed that it is also still potent against Omicron variant strains. HoweverAccording to the time of enrollment, the Omicron mutant strains began to appear from the end of November to December. This EPIC-HR There is only a relatively low proportion of the Omicron strain in the enrolled population of the trial and they have not been vaccinated.For the rapidly spreading COVID-19 Omicron strain, and the population is not vaccinated, In mild cases where the vaccine protection rate is high, Pfizer Paxlovid has not proven to have high efficacy and economic value. Source: Public data, collated by Zhongkang Capital Research Center

MSDMolnupiravir‘s Phase III clinical trial, the primary endpoint of the trial (regression) The results did not appear to be better than PfizerPaxlovid, with a difference of only 3% between the control and drug groups. Similarly, estimated from the time of enrollment, the number of Austrians in the enrolled population of this MOVe-OUT trial was Mikron strains account for a lower proportion.Therefore, for mild cases of the rapidly spreading COVID-19 or Mikron strains and a high population vaccine protection rate, Merck & Co.Molnupiravir has not been proven to have better efficacy and economic value.

Discussion 2: For the currently popular and fast-spreading Omicron patients with mild symptoms, is there any effect of using traditional Chinese medicine alone? considerable efficacy and economic value? The Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine and the Shanghai New Coronary Pneumonia Traditional Chinese Medicine Treatment Expert Group recently released the “Shanghai New Coronary Virus Infection Chinese Medicine Diagnosis and Treatment Expert Consensus (Spring Edition 2022)” )”, Zhang Wei, member of the Shanghai Traditional Chinese Medicine Prevention and Control of New Coronary Pneumonia Expert Group, director of the Respiratory Department of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, and Dr. Sun Meng of the Respiratory Department of Shuguang Hospital jointly answered the relevant knowledge for citizens:Judging from the current experience in the treatment of new coronary pneumonia in many places across the countryOmicron variant strainsChinese medicine,After taking traditional Chinese medicinein patients treated with traditional Chinese medicine, the fever reduction rate was over 70% within 1 day, and the fever reduction rate within 3 days was as high as over 95%, and over 65% of the patients The hospitalization time is less than 7 days, the average nucleic acid conversion time is 4 to 6 days, and the severe conversion rate is less than 0.01%. The public data from the country shows that the cost of a course of Chinese medicine is about more than 100 yuan, so simple The use of traditional Chinese medicine to treat the currently popular and rapidly spreading Omicron patients with mild disease may have considerable curative effect and economic value. ConclusionBased on the actual situation, the current population vaccine protection rate for the fast-spreading Omicron strain is higher than Compared with traditional Chinese medicine treatment, PfizerPaxlovid and Merck Molnupiravir do not have more detailed data to prove higher efficacy and economic value, which also requires more clinical data to prove, and we also look forward to receiving The domestic drugs that come down also have better data unblinding. (New crown case sharing PPT of Shenzhen Third Hospital in the background message)

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