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Background The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations. Aim To evaluate the cost-effectiveness of molnupiravir relative to usual care alone among mainly vaccinated community-based people at higher risk of severe outcomes from COVID-19 over 6 months. Design and setting An economic evaluation of the PANORAMIC trial in the UK. Method A cost-utility analysis that adopted a UK NHS and personal social services perspective and a 6-month time horizon was performed using PANORAMIC trial data. Cost-effectiveness was expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity and subgroup analyses assessed the impacts of uncertainty and heterogeneity. Threshold analysis explored the price for molnupiravir consistent with likely reimbursement. Results In the base-case analysis, molnupiravir had higher mean costs of 449 (95% confidence interval [CI] = 445 to 453) and higher mean QALYs of 0.0055 (95% CI = 0.0044 to 0.0067) than usual care (mean incremental cost per QALY of 81 190). Sensitivity and subgroup analyses showed similar results, except for those aged =75 years, with a 55% probability of being cost-effective at a 30 000 per QALY threshold. Molnupiravir would have to be priced around 147 per course to be cost-effective at a 15 000 per QALY threshold. Conclusion At the current cost of 513 per course, molnupiravir is unlikely to be cost-effective relative to usual care over a 6-month time horizon among mainly vaccinated patients with COVID-19 at increased risk of adverse outcomes, except those aged =75 years.

Original publication




Journal article


British Journal of General Practice


Royal College of General Practitioners

Publication Date



BJGP.2023.0444 - BJGP.2023.0444