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.
Sotrovimab is recommended as an option for treating COVID‑19 in adults and young people aged 12 years and over and weighing at least 40 kg, only if:
they do not need supplemental oxygen for COVID‑19 and
they have an increased risk for progression to severe COVID‑19, as defined in section 5 and
nirmatrelvir plus ritonavir is contraindicated or unsuitable.
Sotrovimab is only recommended if the company provides it according to the commercial arrangement.
Tocilizumab is recommended, within its marketing authorisation, as an option for treating COVID‑19 in adults who:
Casirivimab plus imdevimab is not recommended, within its marketing authorisation, for treating acute COVID‑19 in adults.
Why the committee made these recommendations
About this evaluation
This evaluation reviews the clinical and cost effectiveness of:
casirivimab plus imdevimab, nirmatrelvir plus ritonavir and sotrovimab for mild COVID‑19
casirivimab plus imdevimab and 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 and cost effectiveness
Clinical evidence suggests that:
nirmatrelvir plus ritonavir is effective at treating mild COVID‑19 compared with standard care
sotrovimab is likely to be effective at treating mild COVID‑19 compared with standard care but some of the evidence is uncertain
tocilizumab is effective at treating severe COVID‑19 compared with standard care.
Other evidence suggests that it is highly uncertain that casirivimab plus imdevimab is effective against Omicron variants of COVID‑19.
Nirmatrelvir plus ritonavir and tocilizumab are recommended because the likely cost-effectiveness estimates are within what NICE considers an acceptable use of NHS resources. The cost-effectiveness estimates for sotrovimab are also within what NICE considers an acceptable use of NHS resources, but only for people for whom nirmatrelvir plus ritonavir is contraindicated or unsuitable. So, sotrovimab is recommended in this group.
Casirivimab plus imdevimab is not recommended because it is unlikely to be effective at treating COVID‑19 and it is not possible to reliably estimate its cost effectiveness.