Research report: Cost-effectiveness of antiviral therapies for hospitalized COVID-19 patients at Dr. Hasan Sadikin Hospital, Indonesia: a retrospective real-world analysis

A retrospective real-world analysis from Dr. Hasan Sadikin Hospital in Indonesia has compared the costs and virological responses of three antiviral therapies used in hospitalized COVID-19 patients, finding that point estimates favored favipiravir over a historical oseltamivir comparator, while remdesivir carried higher costs with only a modest incremental improvement in the chosen effectiveness measure. The study, published in Cost Effectiveness and Resource Allocation, drew on data from adults hospitalized during 2020 and 2021.

The research team, led by Cherry Rahayu and colleagues, conducted an individual-level cost-effectiveness analysis using healthcare-provider and limited societal perspectives. Effectiveness was defined as the change in RT-PCR cycle-threshold (CT) value from baseline to the last available measurement. This semi-quantitative virological surrogate was chosen because paired RT-PCR CT values were consistently available in the hospital dataset, whereas patient-centered outcomes were not.

The analysis included 871 patients in total. Of these, 15 received oseltamivir, 554 received favipiravir, and 302 received remdesivir. Oseltamivir was retained as a historical comparator because it was used during the early pandemic under evolving Indonesian treatment guidance, providing a baseline against which the newer antivirals could be assessed.

Mean healthcare costs were IDR 43.95 million for oseltamivir, IDR 29.01 million for favipiravir, and IDR 50.90 million for remdesivir. Mean CT changes were 10.97, 12.30, and 12.08 units respectively, with larger CT changes interpreted as greater virological response on this surrogate measure.

Compared with oseltamivir, favipiravir had a mean cost that was IDR 14.94 million lower and a mean CT change that was 1.33 units greater, a combination the authors describe as point-estimate dominance, meaning the cheaper option also showed the larger effect at the level of point estimates. Remdesivir, by contrast, had a mean cost IDR 6.95 million higher than oseltamivir with a 1.11-unit greater mean CT change, yielding an incremental cost-effectiveness ratio of IDR 6.27 million per additional CT unit.

Uncertainty around these estimates was substantial. The researchers assessed it using 10,000 stratified non-parametric bootstrap replications together with one-way sensitivity analyses. The bootstrap intervals for incremental costs and effects crossed zero, indicating that the observed differences were not statistically robust. Exploratory regression models that adjusted for age, sex, admission year, and baseline CT showed no statistically significant CT differences between the antivirals and oseltamivir, and both adjusted contrasts were negative in direction.

The authors are careful about how the results should be used. Because no accepted willingness-to-pay threshold exists per CT unit, they describe the remdesivir ICER as descriptive only. They also emphasize that the surrogate nature of the CT-based effectiveness measure, the small size of the oseltamivir group of just 15 patients, and the possibility of residual confounding mean the findings should be interpreted as exploratory economic evidence rather than definitive guidance for treatment or reimbursement decisions.

The study addresses a recognized evidence gap. The authors note in the background that the COVID-19 pandemic placed substantial clinical and economic pressure on healthcare systems, particularly in low- and middle-income countries, and that evidence on the cost-effectiveness of antiviral therapies using real-world hospital data in Indonesia remains limited. By using individual-level hospital records rather than modeled inputs, the analysis offers a grounded, if constrained, view of what antiviral treatment actually cost one Indonesian hospital during 2020 and 2021.

The choice of effectiveness measure deserves particular attention when reading the results. The authors explicitly state this surrogate was used because patient-centered outcomes were not available in the source dataset, which limits how directly the economic conclusions translate into clinical benefit for patients.

Overall, the analysis presents a mixed and deliberately cautious picture: favipiravir dominated the historical comparator on point estimates, remdesivir cost more for a modest surrogate gain, and the statistical uncertainty and methodological limitations mean the results are best understood as a contribution to the emerging real-world economic evidence base in Indonesia rather than a basis for immediate clinical or policy change.

Subject of Research: Cost-effectiveness of antiviral therapies for hospitalized COVID-19 patients in Indonesia

Article Title: Cost-effectiveness of antiviral therapies for hospitalized COVID-19 patients at Dr. Hasan Sadikin Hospital, Indonesia: a retrospective real-world analysis

Article References: Rahayu, C., Sinuraya, R. K., Gatera, V. A., Alfaqeeh, M., Fatinah, Y., Abdulah, R., & Suwantika, A. A. (2026). Cost-effectiveness of antiviral therapies for hospitalized COVID-19 patients at Dr. Hasan Sadikin Hospital, Indonesia: a retrospective real-world analysis. Cost Effectiveness and Resource Allocation. https://doi.org/10.1186/s12962-026-00847-5

Image Credits: AI Generated

DOI: 10.1186/s12962-026-00847-5

Keywords: COVID-19, favipiravir, remdesivir, oseltamivir, cost-effectiveness, ICER, Indonesia, hospitalized patients, retrospective analysis, CT value, virological surrogate, health economics