The Real Value of Remdesivir
Could a drug that reduces COVID-19-caused hospitalization by four days have spared our nation months of shut-down and economic devastation?
In May, a pharmaceutical company started giving away thousands of doses of remdesivir, an anti-viral medication that was originally developed to treat Ebola patients after it appeared that coronavirus patients receiving the drug were recovering faster and more often. At the same time and with little fanfare, Gilead, the company that makes the drug, began working with the National Institutes of Health to test remdesivir in a controlled clinical trial.
The company and the NIH stopped the study early because it demonstrated clearly that the drug was better than placebo in reducing the time to recovery. People who were treated with the drug spent 11 days in the hospital instead of 15 days. The Food and Drug Administration immediately allowed remdesivir to be prescribed under an emergency use authorization.
Some groups minimized these results. A private group that insurers use to set drug prices – the Institute for Clinical and Economic Research (ICER) – claims that remdesivir was only worth about $2,800 because it didn’t think four days fewer in the hospital was a big deal. That sentiment was echoed by Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center, who said, “the reason we have shut our whole society down, is not to prevent Covid-19 patients from spending a few more days in the hospital. It is to prevent patients from dying.”
Bach is wrong and so ICER. The reason we shut down society was to avoid the overcrowding of hospitals, ICUs and other medical services because of widespread infection. That’s what flattening the curve was all about. That’s why we sheltered in place and forced our economy to a screeching halt. And if we had remdesivir at the outset, it is likely we wouldn’t have had to endure any of that.
Based on the assumption that 20 percent of the 6.8 million confirmed COVID-19 cases needed to be hospitalized, that’s 1.3 million people. As noted, the length of stay in the ICU is 15 days, with the drug it’s 11 days. Four fewer days in the ICU saves $15,200 per hospitalization. Additionally, every day in the ICU lowers muscle strength 3-11 percent, a reduction that can last months or years. Longer stays in the ICU are also associated with higher death rates regardless of age.
But ICER and Bach suggest these benefits are inconsequential. What’s more, they ignore the fact that remdesivir reduced the mortality rate from 11.6 percent to 8 percent, saving tens of thousands of lives. Hardly inconsequential. Then again, ICER thinks an additional year of life is only worth $50,000. LeBron James earns $117,000 every quarter he plays basketball.
Most important, reducing the number of days in the hospital reduces occupancy rates. At the height of the pandemic, public health officials estimated peak excess demand of more than 17,000 ICU beds then were available nationwide. That’s about 255,000 days in the ICU. If remdesivir had been available there would have been plenty of room in the ICU.
If remdesivir had been available, that alone would have eliminated much of the lockdown and economic destruction imposed on our country. Yet ICER and other remdesivir scolds don’t think the drug added much to health and well-being. To be sure, no one, Gilead included, believe that its medicine should be priced equal to its societal value. But ICER and other remdesivir scolds won’t even acknowledge its worth and they devalue human life in the process. This raises a disturbing question: if ICER oversaw setting the price of drugs and determining their value, would remdesivir have been available at all?
Robert Goldberg is co-founder and vice president of the Center for Medicine in the Public Interest.
