Remdesivir and dexamethasone as tools to relieve hospital care systems stressed by COVID-19: A modelling study on bed resources and budget impact.

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  • Author(s): Béraud G;Béraud G; Timsit JF; Timsit JF; Timsit JF; Leleu H; Leleu H
  • Source:
    PloS one [PLoS One] 2022 Jan 12; Vol. 17 (1), pp. e0262462. Date of Electronic Publication: 2022 Jan 12 (Print Publication: 2022).
  • Publication Type:
    Journal Article; Research Support, Non-U.S. Gov't
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
    • Publication Information:
      Original Publication: San Francisco, CA : Public Library of Science
    • Subject Terms:
      Adenosine Monophosphate/*analogs & derivatives ; Alanine/*analogs & derivatives ; Antiviral Agents/*economics ; Bed Occupancy/*economics ; Dexamethasone/*economics; Adenosine Monophosphate/economics ; Adenosine Monophosphate/therapeutic use ; Alanine/economics ; Alanine/therapeutic use ; Antiviral Agents/therapeutic use ; Bed Occupancy/statistics & numerical data ; COVID-19/economics ; COVID-19/virology ; Dexamethasone/therapeutic use ; France ; Hospitalization/economics ; Hospitalization/statistics & numerical data ; Humans ; Intensive Care Units ; Length of Stay ; Models, Statistical ; SARS-CoV-2/isolation & purification ; COVID-19 Drug Treatment
    • Abstract:
      Remdesivir and dexamethasone are the only drugs providing reductions in the lengths of hospital stays for COVID-19 patients. We assessed the impacts of remdesivir on hospital-bed resources and budgets affected by the COVID-19 outbreak. A stochastic agent-based model was combined with epidemiological data available on the COVID-19 outbreak in France and data from two randomized control trials. Strategies involving treating with remdesivir only patients with low-flow oxygen and patients with low-flow and high-flow oxygen were examined. Treating all eligible low-flow oxygen patients during the entirety of the second wave would have decreased hospital-bed occupancy in conventional wards by 4% [2%; 7%] and intensive care unit (ICU)-bed occupancy by 9% [6%; 13%]. Extending remdesivir use to high-flow-oxygen patients would have amplified reductions in ICU-bed occupancy by up to 14% [18%; 11%]. A minimum remdesivir uptake of 20% was required to observe decreases in bed occupancy. Dexamethasone had effects of similar amplitude. Depending on the treatment strategy, using remdesivir would, in most cases, generate savings (up to 722€) or at least be cost neutral (an extra cost of 34€). Treating eligible patients could significantly limit the saturation of hospital capacities, particularly in ICUs. The generated savings would exceed the costs of medications.
      Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: - GB participated to advisory boards and gave lectures in symposia for Gilead. - JFT reports participation to advisory board for Gilead related to covid-19 antiviral therapies. - HL is employed by PHE which received funding from Gilead. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
    • References:
      Euro Surveill. 2020 Feb;25(5):. (PMID: 32046819)
      N Engl J Med. 2021 Feb 11;384(6):497-511. (PMID: 33264556)
      Respir Med. 2012 Mar;106(3):467-71. (PMID: 22197577)
      Diabet Med. 2011 May;28(5):583-9. (PMID: 21294766)
      N Engl J Med. 2020 Nov 5;383(19):1827-1837. (PMID: 32459919)
      Intensive Care Med. 2021 Jan;47(1):60-73. (PMID: 33211135)
      Nature. 2020 Aug;584(7821):430-436. (PMID: 32640463)
      PLoS One. 2021 Feb 11;16(2):e0246318. (PMID: 33571301)
      N Engl J Med. 2020 Nov 5;383(19):1813-1826. (PMID: 32445440)
      Lancet Public Health. 2020 Aug;5(8):e437-e443. (PMID: 32473113)
      Nat Med. 2020 Sep;26(9):1417-1421. (PMID: 32665655)
      Pneumologie. 2021 Feb;75(2):88-112. (PMID: 33450783)
      Science. 2020 Jul 10;369(6500):208-211. (PMID: 32404476)
      Science. 2020 May 22;368(6493):860-868. (PMID: 32291278)
      Crit Care Med. 2020 Aug;48(8):1196-1202. (PMID: 32697491)
      Lancet Infect Dis. 2020 May;20(5):553-558. (PMID: 32171059)
      Eur J Health Econ. 2010 Dec;11(6):543-54. (PMID: 19997956)
    • Accession Number:
      0 (Antiviral Agents)
      3QKI37EEHE (remdesivir)
      415SHH325A (Adenosine Monophosphate)
      7S5I7G3JQL (Dexamethasone)
      OF5P57N2ZX (Alanine)
    • Publication Date:
      Date Created: 20220112 Date Completed: 20220125 Latest Revision: 20240820
    • Publication Date:
      20240820
    • Accession Number:
      PMC8754316
    • Accession Number:
      10.1371/journal.pone.0262462
    • Accession Number:
      35020746