Original Research

A cost-effectiveness analysis of Molnupiravir and Paxlovid for outpatient treatment of COVID-19 in three African countries

Ijeoma P. Edoka, Tom Drake, Peter Baker, Raji Tajudeen, Elias Asfaw, Javier Guzman, Nicaise Ndembi, Justice Nonvignon, Jean Kaseya
Journal of Public Health in Africa | Vol 16, No 1 | a805 | DOI: https://doi.org/10.4102/jphia.v16i1.805 | © 2025 Ijeoma P. Edoka, Tom Drake, Peter Baker, Raji Tajudeen, Elias Asfaw, Javier Guzman, Nicaise Ndembi, Justice Nonvignon, Jean Kaseya | This work is licensed under CC Attribution 4.0
Submitted: 03 October 2024 | Published: 09 June 2025

About the author(s)

Ijeoma P. Edoka, Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Tom Drake, Center for Global Development, London, United Kingdom
Peter Baker, Center for Global Development, London, United Kingdom
Raji Tajudeen, Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
Elias Asfaw, Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
Javier Guzman, Center for Global Development, London, United Kingdom
Nicaise Ndembi, Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
Justice Nonvignon, Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia; and, School of Public Health, University of Ghana, Legon, Ghana
Jean Kaseya, Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia

Abstract

Background: Two COVID-19 oral antivirals (COAVs), Molnupiravir and Paxlovid, have been shown to be cost-effective in high-income countries.

Aim: This study assesses the cost-effectiveness of Paxlovid and Molnupiravir, compared to usual care in three African countries.

Setting: The study was conducted using data from Ghana, Rwanda and Zambia.

Methods: We modelled costs (2022 United States dollars) and health outcomes in the acute phase of COVID-19 from a public payer’s perspective in three unvaccinated target populations: (1) all adult patients, (2) patients aged 65 years and above (elderly), and (3) adult patients with other underlying risk factors for disease severity. We conducted pairwise and full incremental analyses.

Results: In the pairwise analysis, Paxlovid was less costly and more effective than usual care (i.e. dominated) in all three study countries for elderly patients, while in adults with other underlying risk factors, Paxlovid dominated in Rwanda and Zambia, and Molnupiravir dominated usual care in Rwanda. Neither Paxlovid nor Molnupiravir were cost-effective in the all-adult group in any country context. In the full incremental analysis, Paxlovid dominated both Molnupiravir and usual care in elderly patients (in all three countries) and in adults with other risk factors (in Rwanda and Zambia). Key determinants of cost-effectiveness were COAV price, likelihood of early treatment initiation, hospitalisation rates and vaccination status.

Conclusion: In African settings like Zambia, Ghana or Rwanda, Paxlovid could be cost-effective in unvaccinated populations and those at high risk of progression to severe COVID-19.

Contribution: This study broadly supports African governments decisions not to procure substantial quantities of COAV.


Keywords

cost-effectiveness analysis; COVID-19 oral antivirals; resource allocation; COVID-19; healthcare decision making

Sustainable Development Goal

Goal 3: Good health and well-being

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