Health Intervention and Technology Assessment Programme, Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Rd., Muang, Nonthaburi, Thailand.
Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Appl Health Econ Health Policy. 2023 May;21(3):511-522. doi: 10.1007/s40258-023-00796-7. Epub 2023 Mar 16.
The introduction of Coronavirus disease 2019 (COVID-19) vaccines urged all Thais to seek prevention of serious illness and death from COVID-19. However, immunocompromised individuals might not be able to achieve an efficient immune response from these vaccines. This study aimed to evaluate the cost-effectiveness and budget impact of introducing Evusheld (tixagevimab plus cilgavimab) for three patient groups-organ transplant, autoimmune disease, and dialysis patients, from the Thai government perspective.
A Markov decision model was developed to compare the use of Evusheld plus COVID-19 vaccines versus COVID-19 vaccines alone. The methodology followed the National HTA Guidelines of Thailand. Model input parameters were collected locally from retrospective data and from a literature review.
Evusheld helped prevent COVID-19 infection, severe infection, and death in all three patient groups. Using the Thai threshold of 160,000 Thai Baht (THB) per quality-adjusted life year (QALY) gained, the only scenario found to be cost-effective was that of dialysis patients with inadequate immune response, with an incremental cost-effectiveness ratio (ICER) of 54,700 THB per QALY gained. To make a policy of Evusheld provision cost-effective in other groups, the price of Evusheld had to be lower (a reduction of 44-88% of its current price). The results of one-way sensitivity analysis indicated that the cost-effectiveness of Evusheld was sensitive to changes in the rate of infection, cost and efficacy of Evusheld, proportion of inadequate immune responses, and the probability of moving from a 'recovered' to 'susceptible' status.
Among three COVID-19-vaccinated immunocompromised patient populations, this study concluded that Evusheld was cost-effective for dialysis patients with inadequate immune response to the COVID-19 vaccine.
2019 年冠状病毒病（COVID-19）疫苗的推出促使所有泰国人寻求预防 COVID-19 疾病和死亡。然而，免疫功能低下者可能无法从这些疫苗中获得有效的免疫反应。本研究旨在从泰国政府的角度评估为器官移植、自身免疫性疾病和透析患者引入埃武利单抗（tixagevimab 加 cilgavimab）的成本效益和预算影响。
采用马尔可夫决策模型比较埃武利单抗加 COVID-19 疫苗与 COVID-19 疫苗单独使用的效果。该方法遵循泰国国家卫生技术评估指南。模型输入参数是从当地回顾性数据和文献综述中收集的。
埃武利单抗可预防所有三组患者的 COVID-19 感染、严重感染和死亡。使用泰国每增加一个质量调整生命年（QALY）的阈值为 160,000 泰铢（THB），发现只有透析患者免疫反应不足的方案具有成本效益，增量成本效益比（ICER）为每获得一个 QALY 增加 54,700 THB。为使埃武利单抗提供政策具有成本效益，必须降低埃武利单抗的价格（降低其当前价格的 44-88%）。单因素敏感性分析的结果表明，埃武利单抗的成本效益对感染率、埃武利单抗的成本和疗效、免疫反应不足的比例以及从“康复”到“易感染”状态的概率变化敏感。
在三种 COVID-19 疫苗免疫功能低下的患者群体中，本研究得出结论，对于 COVID-19 疫苗免疫反应不足的透析患者，埃武利单抗具有成本效益。
