Prevention is better than healing. Clinical and economic implications of oral antiviral agents in COVID-19. A prospective study

COVID-19 represents a threat for frailty patients. This study compares molnupiravir and nirmatrelvir for fragile COVID19 patients' efficacy, safety, and cost. An observational, prospective study allowed us to evaluate molnupiravir's efficacy and safety in real life, compare it to a subgroup of patients treated with nirmatrelvir-ritonavir, and analyze its cost-effectiveness. From January to December 2022, 435 patients (225 males, 220 females; median age 72 years), were enrolled; 24 patients were unvaccinated, and 280 patients had >= 2 risk factors. Molnupiravir performed better clinically and economically. Compared to literature data, in these patients, hospitalization was 2.5% vs. 6.8% (P<0.005), overall adverse effects 14,3% vs. 30.4% (P<0.0001), severe adverse effects 2.6 vs. 6.9% (P<0.001), thus involving potential total savings of about _ 92.954 per patient (8% of standard of care cost). Early molnupiravir treatment helped fragile patients who partially responded to the vaccine, or with absolute contraindications to vaccination, to overcome COVID-19 without the need for hospitalization. In elderly patients with multiple pathologies and multiple drugs, molnupiravir prevents disease progression clinically and economically.