1 Recommendations

1.1

Remdesivir is recommended as an option for treating COVID‑19 in hospitals in:

adults, only if they have a high risk of serious illness (risk factors as defined in section 5 of NICE's technology appraisal guidance on nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19)
babies, children and young people, only if they:
- are aged 4 weeks to 17 years and weigh at least 3 kg, and:
  - have pneumonia, and
  - need supplemental oxygen, or
- weigh at least 40 kg, and have a high risk of serious illness (risk factors as defined in section 5 of NICE's technology appraisal guidance on nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID‑19).
  
  Remdesivir is only recommended if the company provides it according to the commercial arrangement.

1.2

Tixagevimab plus cilgavimab is not recommended, within its marketing authorisation, for treating COVID‑19 in adults who do not need supplemental oxygen and who have an increased risk of progression to severe COVID‑19.

Why the committee made these recommendations

Most of the clinical evidence for remdesivir and tixagevimab plus cilgavimab is highly uncertain because it comes from studies done before the dominant Omicron variants of SARS‑CoV‑2 (the virus that causes COVID‑19). Also, some evidence does not reflect clinical practice at the time of this evaluation.

The cost-effectiveness estimates are highly dependent on how well each treatment works compared with standard care, and hospitalisation and mortality rates. Hospitalisation and mortality rates are lower with Omicron variants than earlier variants in the pandemic. These lower rates increase the cost-effectiveness estimates.

Remdesivir in adults

Clinical evidence suggests remdesivir is effective for treating mild COVID‑19 in adults. Clinical evidence on remdesivir for treating COVID‑19 in adults in hospital is highly uncertain. But it suggests that remdesivir can increase how long adults needing low-flow supplemental oxygen live compared with standard care.

The cost-effectiveness estimates for remdesivir are only likely to be within what NICE considers an acceptable use of NHS resources for adults in hospital who have a high risk of serious illness. So, remdesivir is recommended for treating COVID‑19 in this group.

Remdesivir in babies, children and young people

The committee considered remdesivir for babies, children and young people who:

are aged 4 weeks to 17 years, weigh at least 3 kg, and are in hospital with pneumonia and need supplemental oxygen, or
who weigh at least 40 kg, are in hospital and have a high risk of serious illness.

There is limited clinical evidence comparing remdesivir with standard care for treating severe COVID‑19 in these groups. So, the cost-effectiveness estimates are highly uncertain. But there are limited treatment options licensed for these groups and the number who would have remdesivir is very small. So, remdesivir is recommended for treating COVID‑19 in these groups.

Tixagevimab plus cilgavimab in adults

Evidence suggests that it is highly uncertain that tixagevimab plus cilgavimab is effective against Omicron variants of COVID‑19. Because of this, it is not possible to reliably estimate its cost effectiveness, so it is not recommended.