Evaluating the Impact of Molnupiravir in COVID-19 Treatment

By Danélia Botes

April 12, 2024


The healthcare landscape has been dramatically reshaped by the advent of COVID-19, prompting an urgent need for effective treatments. Molnupiravir, a novel antiviral medication, has emerged as a contender in this arena. This article summarises the Molnupiravir COVID-19 impact, particularly for high-risk adults based on the Center for Outcomes Research and Economic Evaluation for Health in Japan.

Molnupiravir COVID-19 Impact

Molnupiravir, introduced at JPY 2,357.80, promised a new horizon in COVID-19 management. The FDA issued an Emergency Use Authorization (EUA) for molnupiravir on December 23, 2021. This was for the treatment of adults with mild to moderate COVID-19 who are at high risk of severe disease. As well as for those whom alternative antiviral therapies are not available or clinically appropriate. Clinical trials initially suggested a reduction in hospitalisation and mortality rates. Yet, the real-world applicability of these findings, particularly in a population now largely vaccinated and facing the Omicron variant, remains under scrutiny.

Economic Considerations

The reimbursement in Japan of molnupiravir, designated as an H1 cost-effectiveness evaluation item, hinges on its economic viability. The manufacturer conducted a cost-effectiveness analysis using a decision-tree model for acute COVID-19 and a Markov model for post-acute COVID-19. A rigorous cost-effectiveness analysis is essential to justify its inclusion in treatment protocols. Especially when the drug does not demonstrate additional benefits over standard care.

Challenges in Generalisability

The MOVe-OUT trial’s relevance to current clinical practice in Japan is debated. Molnupiravir showed a statistically significant reduction in hospitalisation or death rates at day 29 compared to placebo (molnupiravir: 7.3%, placebo: 14.1%). However, with the widespread vaccination and the prevalence of the Omicron variant, the PANORAMIC trial from the UK offers a more pertinent perspective, albeit with its own set of limitations.

The Impact on Elderly Patients

Clinical experts have postulated that older adults might derive more benefit from molnupiravir. However, concrete evidence to substantiate this claim is yet to be established, necessitating further research to clarify its role in this demographic.


The journey of molnupiravir from promising antiviral to a staple in COVID-19 treatment protocols is fraught with questions of clinical efficacy and economic sustainability. As the healthcare industry continues to navigate these challenges, the value-based approach to healthcare remains central to our collective efforts in combating the virus and its effects.

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