Eligibility for Nirmatrelvir/Ritonavir Among Adults With an Acute Care COVID ‐19 Encounter: A Retrospective Cohort Study From Alberta, Canada

This is the authors' abstract. We don't add key points for this paper.

PURPOSE: To describe the characteristics of adults who had a severe coronavirus disease 2019 (COVID-19) outcome during a timeframe that nirmatrelvir/ritonavir (NMV-r; Paxlovid) was available, to assess medical eligibility and receipt of NMV-r before presentation to acute care. METHODS: Population-level administrative data was used to describe adults (≥ 18 years) who had an acute care COVID-19 encounter (hospitalization or emergency department visit with COVID-19) between January 2022 and March 2023 in Alberta, Canada. RESULTS: The 30 793 adults had an acute care COVID-19 encounter; among the 8345 (27.1%) who were assessed as medically eligible for NMV-r, 8111 (97.2%) did not receive outpatient NMV-r ≤ 30 days before the encounter. During the acute care COVID-19 encounter, the proportion who had an all-cause death was 4.7% (received prior NMV-r treatment) and 6.6% (did not) among those who were medically eligible for NMV-r. Of those medically eligible for NMV-r who were hospitalized (n = 4495), the mean length of stay was 9.7 days (SD 11.1) in NMV-r treated and 15.3 days (SD 25.9) in untreated, and the proportion admitted to the intensive care unit was 2.1% in NMV-r treated and 7.6% in untreated. CONCLUSION: Results from this real-world study show that most adults with an acute care COVID-19 encounter who were assessed as medically eligible for NMV-r at the time of presentation had not received this outpatient treatment beforehand in Alberta, Canada, suggesting a potential care gap. If gaps are closed, strain on the acute healthcare system can be alleviated, with attendant improvement in other important patient outcomes.