Nirmatrelvir plus ritonavir is recommended as an option for treating COVID‑19 in adults, only if they:
do not need supplemental oxygen for COVID‑19 and
have an increased risk for progression to severe COVID‑19, as defined in section 5.
This recommendation has been deleted because the company has discontinued manufacturing, supply, distribution and marketing of sotrovimab in the UK.
Tocilizumab is recommended, within its marketing authorisation, as an option for treating COVID‑19 in adults who:
are having systemic corticosteroids and
need supplemental oxygen or mechanical ventilation.
Tocilizumab (branded or biosimilar) is only recommended if the companies provide it according to the commercial arrangement.
This recommendation has been deleted because the conditional marketing authorisation for casirivimab plus imdevimab for treating COVID-19 was withdrawn.
This evaluation reviews the clinical and cost effectiveness of:
nirmatrelvir plus ritonavir for mild COVID‑19
tocilizumab for severe COVID‑19.
Most of the clinical evidence for these treatments is highly uncertain because it comes from studies done before the dominant Omicron variants of SARS‑CoV‑2 (the virus that causes COVID‑19).
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.
Clinical evidence suggests that:
nirmatrelvir plus ritonavir is effective at treating mild COVID‑19 compared with standard care
tocilizumab is effective at treating severe COVID‑19 compared with standard care.
The independent advisory group report commissioned by the Department of Health and Social Care defines people with the highest risk of progression to severe COVID‑19 (see section 5). Nirmatrelvir plus ritonavir is recommended in these groups because the likely cost-effectiveness estimates are within what NICE considers an acceptable use of NHS resources.
Tocilizumab is recommended because the likely cost-effectiveness estimates are within what NICE considers an acceptable use of NHS resources.