Le Rutte Epke A, Shattock Andrew J, Marcelino Inês, Goldenberg Sophie, Penny Melissa A
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
University of Basel, Basel, Switzerland.
EClinicalMedicine. 2024 Jun 21;73:102683. doi: 10.1016/j.eclinm.2024.102683. eCollection 2024 Jul.
In 2023 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared endemic, yet hospital admissions have persisted and risen within populations at high and moderate risk of developing severe disease, which include those of older age, and those with co-morbidities. Antiviral treatments, currently only available for high-risk individuals, play an important role in preventing severe disease and hospitalisation within this subpopulation. Here, we further explore the public health and economic benefits of extending target populations for treatment, and assess efficacy thresholds for a treatment strategy to be cost-saving.
We adapted an individual-based transmission model of SARS-CoV-2, OpenCOVID, which was calibrated and validated to 2020-2023 Swiss, European, and Northern Hemisphere epidemiological data. We used the model to estimate hospitalisations and overall costs for preventatively treating three risk groups for a full range of treatment efficacies and coverages with, besides vaccination and hospital treatments, no other interventions in place. We further calculated efficacy thresholds for strategies to be cost-saving. A global sensitivity analysis was conducted to test the sensitivity of all outcomes for a wide range of treatment properties, emerging variant properties, and vaccination coverages.
In a high vaccination coverage setting, we found that a high efficacy antiviral treatment given to all those at high-risk could reduce hospitalisations by up to 40%. When expanding treatment coverage to also include all those at moderate-risk, an additional 50% of hospitalisations could be averted. Targeting both high-risk and moderate-risk groups was found to be cost-saving for a treatment efficacy greater than ∼40%. This threshold was found to be robust regardless of vaccination coverage and emerging variant properties, but highly sensitive to treatment costs.
For a sufficiently efficacious antiviral treatment, expanding the target population to include both high-risk and moderate-risk groups should be considered. Equitable treatment costs are found crucial in achieving the best possible public health and health economic outcomes.
Botnar Research Centre for Child Health (DZX2165 to MAP), the Swiss National Science Foundation Professorship of MAP (P00P3_203450) and Swiss National Science Foundation NFP 78 Covid-19 2020 (4079P0_198428 to MAP).
2023年，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）被宣布为地方性流行病毒，但在罹患重症风险高和中等的人群中，住院人数持续存在且有所上升，这些人群包括老年人和患有合并症的人。抗病毒治疗目前仅适用于高危个体，在预防该亚人群中的重症疾病和住院方面发挥着重要作用。在此，我们进一步探讨扩大治疗目标人群的公共卫生和经济效益，并评估一种治疗策略实现成本节约的疗效阈值。
我们采用了一种基于个体的SARS-CoV-2传播模型OpenCOVID，该模型已根据2020 - 2023年瑞士、欧洲和北半球的流行病学数据进行校准和验证。我们使用该模型估计在除疫苗接种和住院治疗外无其他干预措施的情况下，对三个风险组进行预防性治疗在一系列治疗疗效和覆盖率下的住院人数和总体成本。我们还计算了策略实现成本节约的疗效阈值。进行了全局敏感性分析，以测试所有结果对广泛的治疗特性、新出现变异株特性和疫苗接种覆盖率的敏感性。
在高疫苗接种覆盖率的情况下，我们发现对所有高危人群给予高效抗病毒治疗可使住院人数减少多达40%。当将治疗覆盖率扩大到也包括所有中危人群时，可避免另外50%的住院情况。对于治疗疗效大于约40%的情况，针对高危和中危人群被发现是成本节约的。无论疫苗接种覆盖率和新出现变异株特性如何，该阈值都很稳健，但对治疗成本高度敏感。
对于一种足够有效的抗病毒治疗，应考虑扩大目标人群以包括高危和中危群体。公平的治疗成本对于实现尽可能好的公共卫生和卫生经济结果至关重要。
博特纳儿童健康研究中心（DZX2165给MAP）、瑞士国家科学基金会MAP教授职位（P00P3_203450）以及瑞士国家科学基金会NFP 78 Covid - 19 2020（4079P0_198428给MAP）。
