Biology, Medicine, & Natural Product Chemistry ISSN 2089-6514 (paper) 

Volume 14, Number 2, October 2025 | Pages: 1219-1223 | DOI: 10.14421/biomedich.2025.142.1219-1223 ISSN 2540-9328 (online) 
 

 

 

 

Cost Effectiveness Analysis of Favipiravir and Oseltamivir as 

Antiretroviral Covid-19 of Patients in Bogor Cisarua Lung Hospital 

 
Ani Rahayu1, Dwi Puspita Sari2, Lukluk Utami Ningsih3, A. Triwildan ST Fatimah4 

1,2Pharmacy Study Program at Binawan University, Jakarta, Indonesia. 
3Cisarua Lung Hospital, Bogor, Indonesia. 

4Raden Mattaher Hospital, Jambi, Indonesia. 

 

 

Corresponding author* 
ani.rahayu@binawan.ac.id 

 

 

 

 

Abstract 

 

Favipiravir is a type of RNA-dependent RNA polymerase (RdRp) inhibitor. Favipiravir is converted by host enzymes to T-705-

ribofuranosyl 5′-triphosphate and may act as a nucleotide analogue that selectively inhibits viral RNA-dependent RNA polymerase or 

causes lethal mutagenesis upon insertion into viral RNA without cytotoxicity in mammalian cells. Oseltamivir is part of the 

neuraminidase inhibitors (NAIs) group which has a mechanism of action by inhibiting viral neuraminidase. Most of the alternative 

therapies for Covid-19 require pharmacoeconomic studies, especially regarding cost-effectiveness analysis which is useful in balancing 

patient expenses by determining treatment alternatives that represent the best health outcomes at a more affordable cost. The aim of this 

study was to compare the cost effectiveness of the antiretrovirals Favipiravir and Oseltamivir. This research method used a descriptive 

analytic cross-sectional design and data collection was carried out retrospectively from the medical records of Covid-19 sufferers while 

detailed data on medical expenses were obtained from the finance department of inpatients at Cisarua Pulmonary Hospital, Bogor for the 

period September-October 2022. Sample of 80 patients consisted of 40 patients using Favipiravir and 40 patients using Oseltamivir.The 

parameters used in this research are direct medical costs (which include doctor visit costs, treatment room costs, laboratory costs and drug 

costs) while the effectiveness uses a negative RT PCR value. The results showed that in patients using Favipiravir with an average length 

of treatment 6.525 days, the total cost was Rp. 9,930,327/patient and Cost-Effectiveness Ratio (RP/day/patient) Rp. 1,521,899.195, 

whereas in patients using Oseltamivir with an average length of treatment 7.925 days, the total cost was IDR. 12,368,397/patient and 

Cost-Effectiveness Ratio (Rp/day/patient) IDR. 1,560,681,009. It can be concluded that Favipiravir is more cost effective than 

Oseltamivir. 

 

Keywords: COVID-19; Favipiravir; Effective and Efficient; Oseltamivir. 

 

 

INTRODUCTION 
 

Corona Virus Diseases 2019 (COVID-19) is a disease 

caused by the severe acute respiratory syndrome 

coronavirus 2 (SARCoV-2). SARCoV-2 is transmitted 

by direct contact with the patient through droplets when 

coughing or sneezing, as well as hands touching the 

mouth, nose, and eyes after touching objects 

contaminated with the virus. It first discovered on 

December 31, 2019. In 3 days, the number of patients 

with these cases amounted to 44 and has continued to 

grow to date, amounting to millions of cases. Initially, 

epidemiological data showed 66% of patients were 

related to one seafood market or fresh market in Wuhan, 

Hubei Province, China. Isolate samples from patients 

were studied, with results showing the presence of 

coronavirus infection, a new type of -coronavirus named 

novel Coronavirus. On March 11, 2020, WHO 

announced that COVID-19 had become a worldwide 

pandemic (Lapostolle F et al. 2020, Lingeswaran M et al. 

2020, Bishnu P. D. et al. 2020, Suresh Kumar VC et al. 

2020, Di Gennaro F et al. 2020) 

The first COVID-19 case in Indonesia was announced 

on March 2, 2020, or about 4 months after the first case 

in China (Lingeswaran M et al. 2020). At the beginning, 

there were hundreds of cases added, and until now, the 

addition of cases has reached millions. At the time, there 

were currently no specific therapies or treatments for 

COVID-19. Nevertheless, some potential drugs have 

been used for people with COVID-19, although they are 

still in test drug status, and the results show good 

effectiveness (Suresh Kumar VC et al. 2020). For acute 

COVID-19 conditions and molecular detection methods, 

NAAT (Nucleid Acid Amplification Test) examinations, 

including RT-PCR examinations of COVID-19 patients 

who are hospitalized, show positive results for antivirals 
such as chloroquinphosphate, hydroxychloroquine, 

Favipiravir, Oseltamivir, remdesivir, and combinations 

between lopinavir and ritonavir (Suresh Kumar VC et al. 

2020, Di Gennaro F et al. 2020) 

Manuscript received: 14 April, 2025. Revision accepted: 04 December, 2025. Published: 11 December, 2025. 

https://doi.org/10.14421/biomedich.2025.142.1219-1223


 

 
 

1220 Biology, Medicine, & Natural Product Chemistry 14 (2), 2025: 1219-1223 

 

 

Favipiravir is a type of RNA- dependent RNA 

polymerase (RdRp) inhibitor (Zhu N, et al. 2019). On 

February 14, a clinical trial of favipiravir for the 

treatment of COVID-19 was initiated by the Clinical 

Medical Research Center of the Third People's Hospital 

of Shenzhen. Preliminary results from a total of 80 

patients (including the experimental group and the 

control group) showed that favipiravir had a stronger 

effect compared to lopinavir and ritonavir. There were no 

adverse reactions or significant side effects in the 

favipiravir treatment group compared to the 

lopinavir/ritonavir group (Suresh Kumar VC, et al. 

2020). Oseltamivir is part of the class of neuraminidase 

inhibitors (NAIs), which have a mechanism of action by 

inhibiting viral neuraminidase and inhibiting the release 

of virus particles from infected cells so as to reduce the 

spread of the virus in the airway (Susilo A,et al. 2019. Y 

Furuta, et al. 2017, Uyeki TM 2018) 

This COVID-19 disease requires a very large 

hospitalization cost of around Rp. 17,808,650 per patient; 

this value is calculated from the costs of drugs, 

treatments, laboratories, and radiology (Di Gennaro F et 

al. 2020). To meet the needs of quality and cost-effective 

health, the cost of treatment must be more affordable for 

the community and effective to get clinical results. Good 

is a negative RT-PCR value, and without drug side 

effects, health policy should go through appropriate 

economic evaluation (Lingeswaran M et al. 2020, Di 

Gennaro F et al. 2020). In August 2022, WHO no longer 

lists oseltamivir as clinical management of COVID-19 in 

health facilities. Study results show that oseltamivir is 

not effective against SARSCOV-2 in both in vitro testing 

and case reports in COVID-19 patients (Uyeki TM 

2018).  

In choosing the priority of the COVID-19 treatment 

strategy using antiretrovirals, favipiravir and oseltamivir, 

which provide the largest rational treatment outcomes, it 

is necessary to conduct a cost- effectiveness assessment 

analysis using the AEB method, which is very good to 

provide the best therapeutic recommendations, estimate 

health progress, and determine the most effective cost for 

COVID-19 treatment that relates the costs needed with 

the outcomes produced (Y Furuta, et al. 2017). This 

research is expected to provide benefits for the nation 

and state in determining the choice of quality and cost-

effective antiretroviral drugs, especially as a 

consideration for policy formulation for the Ministry of 

Health in determining the cost of COVID-19 treatment 

and the resulting outcomes (Y Furuta, et al. 2017). 

 

 

MATERIALS AND METHODS 
 

We used pharmacoeconomic methods that involve 

effectiveness analysis with a cross-sectional research 

design (cross- sectional) and retrospective data search, 

the parameter measured was RT-PCR negative. Results 

are presented in a descriptive- analytic manner. The 

subjects of this study were inpatient COVID-19 patients 

using anti-retroviral favipiravir and oseltamivir at 

Cisarua Lung Hospital, Bogor, for the period September-

October 2022. 

The inclusion criteria in this study were adult Covid-

19: p > 17 years, hospitalized patients diagnosed with 

moderate Covid-19 by doctors (positive RT- PCR value 

(CT < 40), patients undergoing treatment in July–

December 2021, receiving antiretroviral therapy 

Favipiravir and Oseltamivir. The inclusion criteria were 

as follows: pregnant women, patients with unrecorded 

medical records of antiretrovirals used (type, dose, and 

frequency of administration) and no recorded PCR 

examination, patients admitted to the ICU during the 

study process, and patients who died during the study 

process. 

The materials used were medical records and details 

of medical costs for COVID-19 patients at Cisarua Bogor 

Lung Hospital. The samples used were 80 medical 

records, consisting of 40 medical records of patients 

using favipiravir antiretrovirals and 40 medical records 

of patients using oseltamivir antiretrovirals. 

In this study, researchers used the hypothesis test of 

the difference between two populations for the 

calculation of sample size with the formula: 

 

 
 

The medical record data obtained provides 

information about the characteristics of the patient (age, 

sex, length of treatment days, PCR value, drug name, 

dosage, and interval of administration). Cost data 

consists of direct costs obtained from financial 

documents, which include drug costs, laboratory costs, 

doctor consultation fees, and administrative costs. 

Statistical data analysis using the Mann-Whitney 

method was used to compare the statistical significance 

of variability (see meaningful differences between kedua 

antiretroviral Favipiravir and Oseltamivir). 

Pharmacoeconomic analysis, the average cost-

effectiveness ratio (ACER) is the total cost divided by 

the output or effectiveness of each method. The ACER 

generated by each method is then compared; smaller 

values indicate a more cost- effective method compared 

to other methods. Grids are used to describe the cost 

position and outcome of alternative interventions. 

Research Ethics Committee of Stikes Prima 

Indonesia, No. 206/EC/KEPK STIKES-PI/VIII/2022 has 

provided information that passed the ethical review for 

this study.  

 

 



 

 
 

 Rahayu et al. – Cost Effectiveness Analysis of Favipiravir and Oseltamivir as … 1221 
 

 

RESULTS AND DISCUSSION 
 

Characteristics Of Research Subjects 

 
Table 1. Characteristics of Covid 19 patients. 

 

No Variable Category Favipiravir n= 40 Oseltamivir n=40 Total n=80 

1 Gender Man 24 25 49 

  Women 16 15 31 

2 Place of residence Bogor Regency 23 25 48 

  Bogor City 4 7 11 

  Outside Bogor 13 8 21 

3 Length of Days 1 - 8 37 21 58 

 Therapy 9 - 16 3 13 16 

  17 - 24 0 6 6 

4 PCR results positif 30 39 74 

 RS exit Negatif 10 1 6 

 

The study conducted in the COVID-19 treatment 

room of Cisarua Bogor Lung Hospital during a period of 

2 months (September–October 2022), the number of 

hospitalized COVID-19 patients who met the inclusion 

criteria and exclusion criteria was 80 (research sample), 

consisting of 40 patients who received Favipiravir 

antiretroviral and 40 patients who received Oseltamivir 

antiretroviral. Table I Shows the characteristics of 

Inpatient COVID-19 patients in Cisarua Bogor Lung 

Hospital for the July– December 2021 period as follows: 

For sex characteristics, the 80 samples used showed that 

in Favipiravir antiretrovirals, male sex is 24% and female 

sex is 16%, while in Oseltamivir antiretrovirals, male sex 

is 25% and female sex is 15%. This is because men have 

higher levels of enzymes in the blood than women. 

Enzymes are a key factor for COVID-19 to infect human 

cells (Centers for Disease Control and Prevention, 2020 

(9, 10). For patient residences, the 80 samples used 

showed that patients living in Bogor Regency by 48%, 

Bogor City by 11%, and Outside Bogor by 21% showed 

that there were patients living in Bogor City because of 

the hospital. 

 Cisarua Bogor Lung Hospital is a government 

referral hospital for treatment. Covid-19. Length of stay 

(LoS) is a duration of treatment of a patient in a health 

facility. LoS is one of the factors that affect the health 

care system and shows that the longer a patient's stay in 

the hospital, the greater the patient's need for resources, 

including medical personnel, materials, drugs, and 

equipment, resulting in increased costs therapy. The 

length of treatment days for patients taking Favipiravir 

antiretrovirals 1-8 days treatment period is 37%, 9-16 

days is 3%, and there are no patients with 17-24 days of 

treatment, while in Oseltamivir antiretrovirals the 

treatment period is 1-8 days by 21%, 9-16 days by 13%, 

and 17-24 days by 6%. This is in accordance with 

research conducted in China, which shows that the length 

of days of treatment for COVID-patients 19 ranged from 
4 to 53 days, and patients in the ICU ranged from 6 to 12 

days (Song Y et al. 2020, Rees EM et al. 2020). 

Polymerase Chain Reaction (PCR) status when patients 

are discharged from the hospital: for patients using 

Favipiravir antiretrovirals, positive PCR results were 

30% and negative PCR was 10%; for patients using 

Oseltamivir antiretrovirals, positive PCR results were 

39% and negative PCR was 1% (Rees EM et al. 2020, Ye 

Q, Wang B MJ 2020). When viewed from the length of 

treatment days with the patient's PCR status at the time 

of discharge from the hospital, the best antiretroviral 

used for COVID-19 treatment therapy is Favipiravir, 

which is in accordance with the mechanism of action. 

Favipiravir is a type of RNA-dependent RNA 

polymerase (RdRp) inhibitor (Zhu N. et al. 2020). 

On February 14, the clinical trial of favipiravir for the 

treatment of COVID-19 was initiated by the Clinical 

Medical Research Center of the Third People's Hospital 

of Shenzhen. Baseline results from a total of 80 patients 

(including experimental and control groups) showed that 

favipiravir had a stronger effect compared to lopinavir 

and ritonavir. There were no adverse reactions or 

significant side effects in the favipiravir treatment group 

compared to the lopinavir/ritonavir group (Suresh Kumar 

VC et al. 2020). For Oseltamir to provide less than 

maximum results than Favipiravir, this is in line with 

WHO's August 2022 revocation of the use of Oseltamivir 

for the treatment of COVID- 19. 

Cost-effectiveness analysis is obtained by comparing 

the total cost with the effectiveness of the therapy 

obtained (output). Total Cost is a combination of total 

direct costs and indirect costs. 

 

Direct Cost 

 
Table 2. Compares The Cost-Effectiveness of Antiretroviral 
Administration. 

 

 
 

The direct cost component includes the total cost of 

treatment (room fee, drug fee, doctor's visit fee, and 



 

 
 

1222 Biology, Medicine, & Natural Product Chemistry 14 (2), 2025: 1219-1223 

 

 

laboratory fee). In Table 2, the results of the comparison 

of cost-effectiveness in the administration of 

antiretrovirals Favipiravir and Oseltamivir are as follows: 

In patients using Favipiravir, the average total cost is Rp. 

9,930,327 per patient, while in patients using 

Oseltamivir, the average length of treatment days is Rp. 

12,368,397 per patient. 

 

Cost-Effectiveness Analysis 

 

 
Figure 1. Alternative Group Based on Total Cost-Effectiveness of 

Antiretroviral Administration. 

 

Cost-effectiveness analysis is carried out using the 

Average Cost Effectiveness Ratio (ACER) and Cost-

Effectiveness Grid formulas. In this study, the 

Incremental Cost Effectiveness Ratio (ICER) is not 

calculated because the results of the calculation of cost 

effectiveness are included in the table of areas C and G in 

the Cost-effectiveness Grid (meaning that Area G shows 

dominant results and definitely does not need to be 

selected). RIEB/ICER. Area C shows dominant results 

and does not need to be considered as an alternative, so it 

does not need to be included in the RIEB/ICER 

calculation. The ACER price is obtained from a 

comparison between the total cost of treatment and the 

effectiveness of therapy. The effectiveness of therapy 

was measured by the number of days per treatment 

(Afdal AF 2011). 

Based on cost-effectiveness parameters, the ACER 

value based on the length of days from Favipiravir is Rp. 

1,521,899,195 (proportion of treatment days: 6,525), 

while Oseltamivir is Rp. 1,560,681,009. In the 

Favipiravir group, the ACER price was lower than in the 

Oseltamivir group. This suggests that Favipiravir therapy 

is more cost-effective or has the most cost-effectiveness 

compared with Oseltamivir therapy. 

 

 

CONCLUSIONS 
 

Based on the results of this study, it can be concluded 

that the Favipiravir antiretroviral therapy group is more 

cost- effective in the treatment of COVID-19 compared 

to the Oseltamivir antiretroviral therapy group. 

 

 

Acknowledgements: Praise and thank Allah SWT for all 

His mercy and pleasure so that the author can complete 

this writing process. The author would like to thank all 

parties who have played a role in this writing process, 

especially the Directorate General of Higher Education, 

Research, and Technology of the Ministry of Education, 

Culture, Research, and Technology who have funded this 

research. 

 

Competing Interests: The authors declare that there are 

no competing interests. 

 

Funding: This research received funding from 

Directorate General of Higher Education, Research, and 

Technology of the Ministry of Education, Culture, 

Research, and Technology. 

 

 

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