Gallop Katy, Hall Rebekah, Watt Michael, Squirrell Daniel, Branscombe Neil, Arnetop Sofie, Lloyd Andrew
Acaster Lloyd Consulting Ltd, London, United Kingdom.
AstraZeneca UK Ltd., London, United Kingdom.
J Health Econ Outcomes Res. 2024 Jul 24;11(2):20-28. doi: 10.36469/001c.120605. eCollection 2024.
Pre-exposure prophylaxis (PrEP) for COVID-19 provides additional protection, beyond vaccines alone, for individuals who are immunocompromised (IC). This may reduce the need for preventative behavioral modification, such as shielding-a behavioral restriction limiting an IC individual to minimize face-to-face interactions and/or crowded places. Therefore, PrEP may improve psychosocial well-being and health-related quality of life (HRQoL) for individuals with IC conditions. To estimate the potential HRQoL and utility benefit of PrEP for prevention of COVID-19 in individuals with IC conditions who may not have an adequate response of full vaccination (and therefore are at "highest risk" of severe COVID-19) that can be used in future economic evaluations of preventative therapies against COVID-19. Vignettes describing HRQoL associated with 2 pre-PrEP states (shielding and semi-shielding behavioral restrictions) and a post-PrEP state were developed from a literature review and tested through interviews with clinicians (n = 4) and individuals with IC conditions (n = 10). Vignettes were valued by a general population sample (N = 100) using a visual analog scale (VAS), time trade-off (TTO), and EQ-5D-5L. A sample of individuals with IC conditions (n = 48) valued their current HRQoL and a post-PrEP vignette using VAS and EQ-5D-5L. Individuals with IC conditions reported a mean current EQ-5D-5L score of 0.574, and 0.656 for post-PrEP based on the vignette. PrEP would lead to behavior changes for 75% (30/40) of individuals with IC conditions and an emotional benefit for 93% (37/40) of individuals with IC conditions. Mean values from the general population valuation based on EQ-5D-5L ranged from 0.606 ("shielding") to 0.932 ("post-PrEP"). This study quantified the expected health state utility benefit of reduced psychosocial burden and behavioral restriction. PrEP would potentially result in a utility gain between 0.082 and 0.326, dependent on valuation approach and expected change in behavioral restrictions, leading to improvements in daily activities and emotional well-being.
针对新冠病毒的暴露前预防（PrEP），除了单独的疫苗之外，还为免疫功能低下（IC）的个体提供了额外的保护。这可能会减少对预防性行为改变的需求，比如屏蔽——一种行为限制，限制免疫功能低下的个体尽量减少面对面互动和/或前往拥挤场所。因此，PrEP可能会改善免疫功能低下个体的心理社会幸福感和健康相关生活质量（HRQoL）。为了评估PrEP对预防新冠病毒在免疫功能低下个体中潜在的HRQoL和效用益处，这些个体可能对全程接种疫苗没有足够的反应（因此处于严重新冠病毒感染的“最高风险”），这可用于未来针对新冠病毒预防性治疗的经济评估。通过文献综述编写了描述与PrEP前两种状态（屏蔽和半屏蔽行为限制）及PrEP后状态相关的HRQoL的情景描述，并通过对临床医生（n = 4）和免疫功能低下个体（n = 10）的访谈进行了测试。一般人群样本（N = 100）使用视觉模拟量表（VAS）、时间权衡法（TTO）和EQ - 5D - 5L对情景描述进行了估值。一组免疫功能低下个体样本（n = 48）使用VAS和EQ - 5D - 5L对他们当前的HRQoL和PrEP后的情景描述进行了估值。免疫功能低下个体报告的当前EQ - 5D - 5L平均得分为0.574，基于情景描述的PrEP后得分为0.656。PrEP将导致75%（30/40）的免疫功能低下个体出现行为改变，93%（37/40）的免疫功能低下个体获得情感益处。基于EQ - 5D - 5L的一般人群估值的平均值范围为0.606（“屏蔽”）至0.932（“PrEP后”）。本研究量化了心理社会负担和行为限制减轻带来的预期健康状态效用益处。PrEP可能会带来0.082至0.326之间的效用增益，具体取决于估值方法和行为限制的预期变化，从而改善日常活动和情感幸福感。
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