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A new evaluation from the University of Oxford’s ongoing PANORAMIC trial suggests that an antiviral treatment, called molnupiravir, used to treat COVID-19 may not be cost-effective at its current price of £513 per course, compared to usual NHS care and support, in the first six months after infection. However, it may be beneficial for patients over the age of 75.

A healthcare professional discusses care with a patient.

The study, part of the UK-wide PANORAMIC trial, and published in The British Journal of General Practice (BJGP), compared the use of molnupiravir combined with usual care against usual care alone, during the first six months after infection with COVID-19. Usual care varied according to patient needs but did not include molnupiravir. The researchers aimed to measure if the benefits of adding the antiviral treatment, in terms of improved health outcomes over the first six months, warranted the additional costs associated with the drug.  

To do this, they used a common measure called a ‘quality adjusted life year’ or QALY, which is a standard way of measuring a person’s health outcomes, based on the length and health-related quality of their life. Comparing this measure for usual care against usual care with molnupiravir can help decision-making organisations see if a new treatment makes enough of a difference to a person’s quality and length of life to warrant its cost. 

The researchers worked with participants aged 50 or over, or over 18 but who had underlying health conditions such as certain cancers or autoimmune conditions, who had shown symptoms of COVID-19 in the past five days. Almost all of the participants had been vaccinated against COVID-19. 

Molnupiravir, is an antiviral medication that was given emergency authorisation in the UK for treatment of COVID-19. It works by stopping SARS-CoV-2 – the virus that causes COVID-19 – from growing, so virus levels in the body remain lower. 

The NHS, advised by the National Institute for Health and Care Excellence (NICE) in England and Wales, uses the idea of ‘cost effectiveness’ to see if the additional costs associated with a treatment are justified by its benefits (usually measured in terms of the additional QALYs it generates). 

Dr May Ee Png, Senior Researcher in Health Economics at the Nuffield Department of Primary Care Health Sciences and lead author of the paper, said: Participants of the study kept diary entries and completed questionaries to record the type and frequency of care they needed for their COVID-19 symptoms over a six-month period. We used this information to assess how quickly the participants got better and then assessed if taking molnupiravir made a significant difference to the length and severity of their illness, using QALYs. 

Professor Stavros Petrou, Academic Research Lead at the Nuffield Department of Primary Care Health Sciences, and co-author said: “We found that prescribing molnupiravir increases NHS and personal social services costs, on average, by £449. Although molnupiravir is associated with a slight increase in QALYs of 0.0055, on average, it is generally not a cost-effective approach when compared to usual care for treating COVID-19 in at-risk adults. However, we did find that participants over the age of 75 saw greater benefits from taking molnupiravir to treat COVID-19 over the first six-month period, so it may be cost-effective for the NHS to consider it as a treatment for this group.” 

The findings, say the authors, could be crucial in helping policy makers and health services policy makers who must balance the costs and benefits of new medications to decide how to allocate scarce resources for treating COVID-19, especially for at-risk adults.  

The full article is available in the British Journal of General Practice 

PANORAMIC is led by the University of Oxford and funded by UK Research and Innovation (UKRI) and National Institute for Health and Care Research (NIHR). (NIHR135366). 

The study will now continue to investigate new antiviral medications such as Paxlovid. For more information or to enrol, please visit 




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