Impact of Implementing More Restrictive Remdesivir Criteria Across a Multi-Hospital Health System
et al., Am. J. Health-Syst. Pharm., doi:10.1093/ajhp/zxaf258, Mar 2026
Retrospective 2,249 hospitalized COVID-19 patients showing lower mortality after restricting remdesivir use. Mortality reduced from 7.6% to 5.6% (p = 0.12) after restriction. No baseline details are provided and results are subject to confounding by time, however both periods were post-pandemic with comparable risk.
Gérard, Zhou, Wu, Kamo, Choi, Kim show increased risk of acute kidney injury, Leo, Briciu, Muntean, Petrov, Arch show increased risk of liver injury, Negru, Cheng, Mohammed, Kwok, Zhu show increased risk of cardiac disorders, and Kwok, Merches, Akinci, Tang, Bagheri show increased risk of mitochondrial toxicity with remdesivir.
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Nicholson et al., 6 Mar 2026, retrospective, USA, peer-reviewed, 3 authors.
Abstract: PROFESSIONAL POSTERS
Impact of Implementing More Restrictive Remdesivir Criteria
Across a Multi-Hospital Health System
Type: Professional Posters
Topic: Infectious Diseases/HIV
Category: Evaluative Study
Primary Author: James P. Nicholson, PharmD, BCPS, Clinical
Pharmacy Manager, Methodist Medical Center of Oak Ridge
Conclusion: The implementation of more restrictive remdesivir
criteria at Covenant Health led to a signi"cant reduction in drug
utilization and generated over $500,000!in cost savings. Importantly,
these changes did not negatively impact clinical outcomes, including
length of stay, mortality, and 30-day readmissions. The cost savings
were consistent compared to a national benchmark, underscoring
the e#ectiveness of targeted stewardship interventions in optimizing
resource utilization in Covid-19!patients.
Co-Author(s): John W. Gilliam, Jesse T. Doers
Purpose: During the COVID-19!pandemic, Covenant Health
initially aligned its remdesivir use criteria with NIH guidelines. In
May 2024, the System Pharmacy and Therapeutics Committee,
following a recommendation from the COVID-19!Subcommittee,
approved more restrictive criteria. These limited remdesivir use to
immunocompromised patients with oxygen requirements within
48!hours of admission and within 10!days of symptom onset. The
updated criteria were implemented in the electronic medical record
in July 2024. This study aimed to evaluate the clinical and "nancial
impact of this change across the health system.
Methods: This retrospective, multi-center study compared remdesivir
use across eight acute care hospitals during two nine-month periods:
pre- (July 2023!to March 2024) and post- (July 2024!to March 2025)
implementation of more restrictive criteria. COVID-19!patients were
identi"ed using ICD-10!codes. Remdesivir data collected included the
number of patients that received the drug, the quantity of 100!mg
vials charged, and associated costs. Pharmacists reviewed remdesivir
orders and contacted providers to discontinue therapy when patients
did not meet the updated criteria. Clinical outcomes assessed
included length of stay, mortality, and 30-day readmission rates. Two
cost analyses were conducted: one adjusted total remdesivir costs
in the pre-implementation group to match the patient volume of
the post-implementation group, and the other compared remdesivir
cost per pharmacy-adjusted patient day with a national benchmark
of approximately 120!healthcare facilities. Data were obtained from
analytics platforms, and statistical analysis was performed using the
Student’s t-test.
Results: The pre-implementation group included 1,249!COVID19!patients, compared to 1,000!in the post-implementation group.
There were no statistically signi"cant di#erences in clinical outcomes
between the two groups. The average length of stay was 5.96!days
in the pre-implementation group versus 5.72!days in the postimplementation group (p!=!0.34). Mortality rates were 7.57% and
5.61% (p!=!0.12), respectively, and 30-day readmission rates were
18.3% and 20.3% (p!=!0.30), respectively. In contrast, remdesivir
utilization signi"cantly decreased. The number of patients receiving
remdesivir dropped from 414!to 147!(p <!0.001), and the number
of 100!mg vials charged decreased from 1,960!to 629!(p <!0.001).
The percentage of COVID-19!patients receiving remdesivir declined
from 32.8% to 15.5% (p..
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Late treatment
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is less effective
