Economic and clinical impact of a novel, light-based, at-home antiviral treatment on mild-to-moderate COVID-19

Figures & data

Figure 1. Cost-consequence model schematic. Abbreviations. COVID-19: coronavirus disease 2019; MV, mechanical ventilation.

Table 1. COVID-19 testing, disease severity, and symptoms²⁷.

	FDA authorized SARS-CoV-2 diagnostic test	Clinical signs and symptoms
Mild COVID-19	(+)	Symptoms of mild illness with COVID-19 that could include fever, cough, sore throat, headache, muscle or joint pain, unexplained chills or sweats, nausea (with or without vomiting) or other non-respiratory symptoms that may alter daily living (e.g. loss of taste or smell), and Do not have shortness of breath, dyspnea, abnormal chest imaging, or any other clinical signs indicative of moderate or severe COVID-19.
Moderate COVID-19	(+)	Symptoms of moderate illness with COVID-19, which could include any symptom of mild illness or dyspnea (shortness of breath) with exertion, and Clinical signs suggestive of lower airway involvement, such as resting respiratory rate ≥20 breaths per minute or imaging indicating lower airway disease with an oxygen saturation (SpO2) ≥94% on room air at sea level.
Severe COVID-19	(+)	Symptoms suggestive of severe systemic illness with COVID-19, which could include any symptom of moderate illness or shortness of breath at rest, and Clinical signs indicative of severe systemic illness, such as resting respiratory rate ≥30 per minute, heart rate ≥125 per minute, lung infiltrates >50%, or SpO2 < 94% on room air at sea level or PaO2/FiO2 < 300 mm Hg.

Adapted from National Institutes of Health Center for Drug Evaluation Research (NIH CDER)²⁸.

Abbreviations. +, SARS-CoV-2-positive; COVID-19, coronavirus disease 2019; FDA, Food and Drug Administration; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Table 2. Model inputs.

Parameter		Base case value	Range in deterministic sensitivity analyses		Distribution for probabilistic analyses	Source
			Lower	Upper
Population characteristics
US National	Total population, n	329,301,587	–	–	None	^29
	Population ≥18 years, %	77.90%	70.11%	85.69%	Beta
	Gender (female), %	50.80%	45.72%	55.88%	Beta
	Average age of adult population, years	38.5	34.7	42.4	Normal
	Adults initially infected with COVID-19 (March 2020), %	0.000161%	0.00014%	0.00018%	Beta	^30
Alabama	Total population, n	4,903,185	–	–	None	^29
	Population ≥18 years, %	77.80%	70.02%	85.58%	Beta
	Gender (female), %	51.70%	46.53%	56.87%	Beta
	Average age of adult population, years	39.4	35.5	43.3	Normal
	Adults initially infected with COVID-19 (March 2020), %	0.01081%	0.00973%	0.01189%	Beta	^30
North Carolina	Total population, n	10,488,084	–	–	None	^29
	Population ≥18 years, %	78.10%	70.29%	85.91%	Beta
	Gender (female), %	51.40%	46.26%	56.54%	Beta
	Average age of adult population, years	39.1	35.2	43.0	Normal
	Adults initially infected with COVID-19, %	0.000639%	0.000575%	0.000703%	Beta	^29
Massachusetts	Total population, n	6,892,503	–	–	None	^29
	Population ≥18 years, %	80.40%	72.36%	88.44%	Beta
	Gender (female), %	51.50%	46.35%	56.65%	Beta
	Average age of adult population, n	39.7	35.7	43.7	Normal
	Adults initially infected with COVID-19, %	0.00001%	0.00001%	0.00002%	Beta	^30
COVID-19 infections
COVID-19 infections positively diagnosed, %		23.81%	20.41%	27.78%	Beta	^30
Baseline distribution, %	Mild COVID-19	74.24%	–	–	Dirichlet	^31
	Moderate COVID-19	14.19%	–	–	Dirichlet
	Severe COVID-19	11.57%	–	–	Dirichlet
COVID-19 incubation period, days		5.20	4.68	5.72	Normal	^32
Moderate COVID-19 cases resolved at home, %		75.67%	68.10%	83.23%	Beta	^27
Severe COVID-19 cases requiring MV, %		30.50%	27.45%	33.55%	Beta	^33
COVID-19 symptomatic days, days	Mild	6.71	6.04	7.38	Normal	^23
	Moderate (Home)	6.71	6.04	7.38	Normal
	Moderate (Hospital)	17.00	15.30	18.70	Normal	^34
	Severe (without MV)	21.00	18.90	23.10	Normal
	Severe (with MV)	23.00	20.70	25.30	Normal
COVID-19 recovery days, days	Mild	12.00	10.80	13.20	Normal	^35
	Moderate (Home)	12.00	10.80	13.20	Normal
	Moderate (Hospital)	12.00	10.80	13.20	Normal
	Severe (without MV)	12.58	11.32	13.84	Normal	^34
	Severe (with MV)	28.00	25.20	30.80	Normal
COVID-19 cases progressing, %	Mild COVID-19 to Moderate COVID-19	5.77%	5.19%	6.35%	Beta	^36
	Moderate COVID-19 to Severe COVID-19	20.20%	18.18%	22.22%	Beta	^37
COVID-19 progression, time to progress, days	Mild COVID-19 to Moderate COVID-19	29.00	26.10	31.90	Normal	^36
	Moderate COVID-19 to Severe COVID-19	14.00	12.60	15.40	Normal	^37
Long COVID-19	After mild infection, %	32.67%	29.40%	35.93%	Beta	^38
	After mild infection, %	31.25%	28.13%	34.38%	Beta
	After mild infection, %	31.25%	28.13%	34.38%	Beta
	Duration, days	180.00	162.00	198.00	Normal	^39
Vaccination inputs
Vaccine efficacy, %	Reduction in infections	95.00%	85.50%	100.00%	Beta	^40
	Reduction in hospitalizations	86.00%	77.40%	94.60%	Beta	^41
Intervention efficacy
Reduction in infectious days, days	Mild COVID-19	2.38	2.14	2.61	Normal	^23
	Moderate (Home) COVID-19	2.38	2.14	2.61	Normal
Costs
RD-X19 device cost, $		$0	–	–	None
Health-state costs, $	Mild COVID-19	$57	$51	$63	Gamma	^9
	Moderate (Home) COVID-19	$3,045	$2,741	$3,350	Gamma
	Moderate (Hospital) COVID-19	$9,763	$8,787	$10,739	Gamma	^42
	Severe COVID-19 (without MV)	$14,366	$12,929	$15,803	Gamma	^9
	Severe COVID-19 (with MV)	$33,247	$29,922	$36,572	Gamma	^43
	Post-mild COVID-19	$0	$0	$0	Gamma	^Assumption
	Post-moderate COVID-19	$1,743	$1,569	$1,918	Gamma	^9
	Post-severe COVID-19	$4,213	$3,792	$4,634	Gamma
	Long COVID-19	$0	$0	$0	Gamma	^Assumption
	Recovered	$0	$0	$0	Gamma	^9

Table 3. Total cost saving and cost saving per person receiving RD-X19.

Costs saving per person per state receiving RD-X19		RD-X19 uptake: Proportion of individuals diagnosed with Mild COVID-19 or Moderate (Home) COVID-19 and receiving RD-X19 (%)
		5%	10%	25%
Efficacy of RD-X19 for Mild COVID-19 or Moderate (Home) COVID-19 individuals	Alabama
	150% (3.6 days)	−$3,011	−$3,043	−$3,140
	100% (2.4 days)	−$2,001	−$2,015	−$2,057
	50% (1.2 days)	−$997	−$1,000	−$1,011
	North Carolina
	150% (3.6 days)	−$3,229	−$3,269	−$3,392
	100% (2.4 days)	−$2,144	−$2,161	−$2,215
	50% (1.2 days)	−$1,068	−$1,072	−$1,085
	Massachusetts
	150% (3.6 days)	−$3,756	−$3,808	−$3,969
	100% (2.4 days)	−$2,492	−$2,515	−$2,586
	50% (1.2 days)	−$1,241	−$1,246	−$1,263
	US National
	150% (3.6 days)	−$3,262	−$3,303	−$3,429
	100% (2.4 days)	−$2,166	−$2,184	−$2,239
	50% (1.2 days)	−$1,078	−$1,083	−$1,096
Total costs per state		RD-X19 uptake: Proportion of individuals diagnosed with Mild COVID-19 or Moderate (Home) COVID-19 and receiving RD-X19 (%)
		5%	10%	25%
Efficacy of RD-X19 for Mild COVID-19 or Moderate (Home) COVID-19 individuals	Alabama
	150% (3.6 days)	−$51,734,270	−$102,613,045	−$250,164,905
	100% (2.4 days)	−$34,584,791	−$68,788,691	−$169,128,810
	50% (1.2 days)	−$17,340,089	−$34,584,791	−$85,748,225
	North Carolina
	150% (3.6 days)	−$101,783,931	−$201,715,989	−$490,498,555
	100% (2.4 days)	−$68,062,155	−$135,299,936	−$332,094,333
	50% (1.2 days)	−$34,134,283	−$68,062,155	−$168,610,507
	Massachusetts
	150% (3.6 days)	−$76,821,422	−$151,785,366	−$365,729,833
	100% (2.4 days)	−$51,421,489	−$102,014,940	−$248,880,202
	50% (1.2 days)	−$25,814,535	−$51,421,489	−$127,002,692
	US National
	150% (3.6 days)	−$3,316,141,651	−$6,572,031,814	−$15,980,911,318
	100% (2.4 days)	−$2,217,467,578	−$4,408,120,862	−$10,819,943,826
	50% (1.2 days)	−$1,112,089,834	−$2,217,467,578	−$5,493,414,397

Base case results are indicated by a blue fill. The incremental cost represents the total cost difference between the RD-X19 and standard practice arms of the model split across all individuals eligible to receive RD-X19. A negative result indicates that switching to RD-X19 leads to a cost reduction.

Abbreviation. COVID-19, coronavirus disease 2019.

Figure 2. Deterministic and probabilistic sensitivity analyses by state. Abbreviation. MV, mechanical ventilation.

Figure 3. Number of cases by severity prevented by state as a function of RD-X19 clinical benefit.

Table 4. Lives saved and cases reduced as a function of efficacy and date of introduction of RD-X19 (base case with 10% penetration).

			RD-X19 introduction: Month where RD-X19 becomes available
			Total incremental infections			Total incremental deaths
			12 months (From June 2020)	8 months (From October 2020)	4 months (From February 2020)	12 months (From June 2020)	8 months (From October 2020)	4 months (From February 2020)
RD-X19 efficacy: effectiveness of RD-X19 for Mild COVID-19 or Moderate (Home) COVID-19 individuals	Alabama
	150% 3.6 days	Mild	−11,164	−4,246	−394	−1	−1	0
		Moderate	−2,130	−809	−74	−19	−8	−1
		Severe	−1,729	−656	−60	−389	−164	−19
		Total	−15,023	−5,712	−527	−410	−172	−20
	100% (Nominal) 2.4 days	Mild	−7,476	−2,830	−263	−1	−1	0
		Moderate	−1,426	−539	−50	−13	−5	−1
		Severe	−1,158	−437	−40	−261	−109	−13
		Total	−10,059	−3,807	−352	−275	−115	−13
	50% 1.2 days	Mild	−3,754	−1,415	−132	0	0	0
		Moderate	−716	−270	−25	−7	−3	0
		Severe	−581	−219	−20	−131	−55	−6
		Total	−5,052	−1,903	−176	−138	−58	−7
	North Carolina
	150% 3.6 days	Mild	−23,422	−9,988	−1,472	−2	−2	−1
		Moderate	−4,455	−1,897	−277	−39	−18	−3
		Severe	−3,600	−1,528	−220	−771	−353	−58
		Total	−31,476	−13,413	−1,969	−812	−373	−62
	100% (Nominal) 2.4 days	Mild	−15,695	−6,663	−982	−2	−1	0
		Moderate	−2,985	−1,265	−185	−26	−12	−2
		Severe	−2,412	−1,019	−147	−517	−236	−39
		Total	−21,092	−8,948	−1,314	−545	−249	−41
	50% 1.2 days	Mild	−7,888	−3,334	−491	−1	−1	0
		Moderate	−1,500	−633	−92	−13	−6	−1
		Severe	−1,212	−510	−73	−260	−118	−19
		Total	−10,600	−4,477	−657	−274	−125	−21
	Massachusetts
	150% 3.6 days	Mild	−18,523	−7,939	−1,385	−2	−1	0
		Moderate	−3,501	−1,496	−258	−30	−14	−3
		Severe	−2,798	−1,190	−200	−586	−272	−52
		Total	−24,821	−10,625	−1,843	−618	−287	−56
	100% (Nominal) 2.4 days	Mild	−12,442	−5,295	−924	−1	−1	0
		Moderate	−2,351	−998	−172	−20	−9	−2
		Severe	−1,877	−793	−134	−394	−181	−35
		Total	−16,670	−7,085	−1,229	−415	−192	−37
	50% 1.2 days	Mild	−6,268	−2,649	−462	−1	0	0
		Moderate	−1,184	−499	−86	−10	−5	−1
		Severe	−945	−396	−67	−198	−91	−17
		Total	−8,397	−3,544	−615	−209	−96	−19
	US National
	150% 3.6 days	Mild	−762,815	−316,004	−47,135	−81	−52	−16
		Moderate	−144,990	−59,952	−8,858	−1,268	−567	−96
		Severe	−117,022	−48,232	−7,008	−25,126	−11,272	−1,822
		Total	−1,024,827	−424,187	−63,001	−26,475	−11,891	−1,933
	100% (Nominal) 2.4 days	Mild	−511,178	−210,771	−31,440	−54	−35	−11
		Moderate	−97,149	−39,984	−5,908	−850	−379	−64
		Severe	−78,394	−32,163	−4,674	−16,844	−7,522	−1,214
		Total	−686,722	−282,918	−42,022	−17,748	−7,935	−1,289
	50% 1.2 days	Mild	−256,908	−105,435	−15,728	−27	−17	−5
		Moderate	−48,820	−20,000	−2,955	−427	−189	−32
		Severe	−39,387	−16,086	−2,338	−8,468	−3,764	−607
		Total	−345,114	−141,521	−21,021	−8,923	−3,971	−644

Base case results are indicated by a blue fill. A negative result indicates that switching to RD-X19 results in a reduction in the total number of individuals infected and diagnosed with COVID-19 individuals in the model as well as a reduction in the total number of COVID-19-related deaths across the model time horizon (1 June 2020 to 31 May 2021).

Abbreviation.COVID-19, coronavirus disease 2019.

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