Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA.
Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2023 Aug 14;38(32):e250. doi: 10.3346/jkms.2023.38.e250.
Tixagevimab and cilgavimab (Evusheld) administration is a recommended strategy for unvaccinated patients with immunocompromised conditions and severe allergic reaction conditions to protect high-risk individuals and control the coronavirus disease 2019 (COVID-19) epidemic. We estimated the cost-effectiveness of Evusheld in key risk populations: 1) immunocompromised (vaccinated/unvaccinated), 2) severe allergic reaction, and 3) unvaccinated elderly high-risk groups.
Based on the estimated target risk group population, we used a model of COVID-19 transmission to estimate the size of the risk group population for whom Evusheld treatment may help prevent symptomatic COVID-19 (and deaths) in 2022. We projected Evusheld intervention costs, quality-adjusted life year (QALY) lost, cost averted and QALY gained by reduced COVID-19 incidence, and incremental cost-effectiveness (cost per QALY gained) in each modeled population from the healthcare system perspective.
Our study demonstrated that Evusheld treatment for COVID-19 infection in South Korea is highly cost-effective for unvaccinated risk groups ($18,959 per QALY gained for immunocompromised and $23,978 per QALY gained for high-risk elderly groups) and moderately cost-effective among individuals who are vaccinated immunocompromised ($46,494 per QALY gained), or have severe allergic reactions ($45,996 per QALY gained). Evusheld's cost-effectiveness may be subject to risk-group-specific COVID-19 disease progression and Evusheld efficacy and cost, which may change in future epidemic scenarios.
As the COVID-19 variants and risk group-specific durable efficacy, toxicity (and/or resistance) and optimal dosing of Evusheld remain uncertain, better empirical estimates to inform these values in different epidemiological contexts are needed. These results may help decision-makers prioritize resources toward more equitable and effective COVID-19 control efforts.
替沙格韦单抗和西加韦单抗（Evusheld）的给药是一种针对免疫功能低下和严重过敏反应条件的未接种患者的推荐策略，旨在保护高危人群并控制 2019 年冠状病毒病（COVID-19）疫情。我们评估了 Evusheld 在关键风险人群中的成本效益：1）免疫功能低下（已接种/未接种），2）严重过敏反应，3）未接种的老年高危人群。
基于估计的目标风险人群规模，我们使用 COVID-19 传播模型来估计可能需要 Evusheld 治疗以预防 2022 年有症状 COVID-19（和死亡）的风险人群规模。我们从医疗保健系统的角度预测了 Evusheld 干预成本、丧失的质量调整生命年（QALY）、因 COVID-19 发病率降低而避免的成本和获得的 QALY，以及每个建模人群中增量成本效益（每获得一个 QALY 的成本）。
我们的研究表明，在韩国，Evusheld 治疗 COVID-19 感染对未接种风险人群具有很高的成本效益（免疫功能低下人群每获得一个 QALY 的成本为 18959 美元，高危老年人群每获得一个 QALY 的成本为 23978 美元），对于接种免疫功能低下人群（每获得一个 QALY 的成本为 46494 美元）或有严重过敏反应人群（每获得一个 QALY 的成本为 45996 美元），也具有中度成本效益。Evusheld 的成本效益可能取决于风险人群特有的 COVID-19 疾病进展和 Evusheld 的疗效和成本，这些因素可能会在未来的疫情情景中发生变化。
由于 COVID-19 变异和风险人群特异性持久疗效、毒性（和/或耐药性）以及 Evusheld 的最佳剂量仍不确定，因此需要在不同的流行病学背景下获得更好的经验估计值来提供这些值。这些结果可能有助于决策者将资源优先用于更公平和有效的 COVID-19 控制工作。
