Evolving Pattern of Remdesivir Prescribing During the COVID-19 Pandemic: Outcome and Cost Implications
Anthony Sophonsri, Pamela Ny, Paul Nieberg, Annie Wong-Beringer
Purpose: Remdesivir has become a part of the treatment standard for patients hospitalized with COVID-19 since its initial availability under the Expanded Access Program in March 2020. Here, we describe our evolving experience with remdesivir utilization during the pandemic. Methods: Medical records of patients prescribed remdesivir during March to December 2020 at a community teaching hospital were reviewed for baseline characteristics, clinical presentation and management, outcomes, and cost of remdesivir treatment. The pattern of remdesivir prescribing was compared pre- and post-formulary addition of the drug for use in hospitalized COVID-19 patients. Results: Criteria for remdesivir use evolved from requiring mechanical ventilation to requiring low oxygen supplementation during the study period. A 3.5-fold increase in remdesivir use outside of criteria was observed after formulary addition when much of the prescribing was shifted from Infectious Diseases (ID) and Pulmonary Critical Care Medicine (PCCM) to the Internal Medicine service. Compared to Pre-formulary patients, Post-formulary patients had lower requirements for oxygen supplementation and more achieved early clinical response with <5 days of remdesivir (29.7% vs. 9.2%, p<0.0001), had significantly shorter time to stability (median 4 vs. 6.5 days, p<0.0001) and length of stay (6 vs. 10 days, p<0.0001), and lower mortality (9.9% vs. 15.5%, p=0.19). None of the patients who achieved early response and received <5 days of remdesivir had a COVID-related readmission or emergency department (ED) visit within 30 days. Potential cost savings per 100 patients is estimated at $35,000 with strict adherence to criteria and an additional $15,444 when treatment duration is shortened to 4 days in the early responders. Conclusion: Prescribing of remdesivir outside of criteria increased after it was no longer restricted to ID or PCCM specialists upon formulary addition. Provider education is needed to improve adherence to criteria-based prescribing. Shortening treatment duration in early responders can lessen healthcare resource utilization and cost without negatively impacting patient outcomes.
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