Kowal Stacey, Rosettie Katherine L
Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA.
Pharmacoeconomics. 2025 Jan;43(1):67-82. doi: 10.1007/s40273-024-01436-1. Epub 2024 Oct 10.
We conducted a distributional cost-effectiveness analysis to evaluate how coverage of tocilizumab for inpatients with COVID-19 from 2021 to present impacted health equity in the USA.
A published, payer-perspective, distributional cost-effectiveness analysis for inpatient COVID-19 treatments was adapted to include information on baseline health disparities across 25 equity-relevant subgroups based on race and ethnicity (5 census-based groups), and county-level social vulnerability (5 geographic quintiles). The underlying cost-effectiveness analysis was updated to reflect patient characteristics at admission, standard of care outcomes, tocilizumab efficacy, and contemporary unit costs. The distributional cost-effectiveness analysis inputs for COVID-19 hospitalization and subgroup risk adjustments based on social vulnerability were derived from published estimates. Opportunity costs were estimated by converting total tocilizumab spend into quality-adjusted life-years (QALYs), distributed equally across subgroups.
Tocilizumab treatment was cost effective across all subgroups. Treatment resulted in larger relative QALY gains in more socially vulnerable subgroups than less socially vulnerable subgroups, given higher hospitalization rates and inpatient mortality. Using an opportunity cost threshold of US$150,000/QALY and an Atkinson index of 11, tocilizumab was estimated to have improved social welfare by increasing population health (53,252 QALYs gained) and reducing existing overall US health inequalities by 0.003% since 2021.
Use of tocilizumab for COVID-19 since 2021 increased population health while improving health equity, as more patients with lower baseline health were eligible for treatment and received larger relative health gains. Future equitable access to tocilizumab for inpatients with COVID-19 is expected to lead to continued increases in population health and reductions in disparities.
我们进行了一项分布性成本效益分析，以评估2021年至今托珠单抗用于新冠肺炎住院患者的覆盖范围如何影响美国的健康公平性。
对已发表的、从支付方角度进行的新冠肺炎住院治疗分布性成本效益分析进行调整，纳入基于种族和族裔（5个基于人口普查的群体）以及县级社会脆弱性（5个地理五分位数）的25个与公平性相关亚组的基线健康差异信息。更新基础成本效益分析以反映入院时的患者特征、护理标准结局、托珠单抗疗效和当代单位成本。新冠肺炎住院治疗的分布性成本效益分析输入数据以及基于社会脆弱性的亚组风险调整数据来自已发表的估计值。通过将托珠单抗总支出转化为质量调整生命年（QALY）来估计机会成本，并在各亚组间平均分配。
托珠单抗治疗在所有亚组中均具有成本效益。鉴于较高的住院率和住院死亡率，在社会脆弱性较高的亚组中，治疗带来的相对QALY增益比社会脆弱性较低的亚组更大。使用150,000美元/QALY的机会成本阈值和11的阿特金森指数，估计自2021年以来，托珠单抗通过提高人群健康（获得53,252个QALY）和将美国现有的总体健康不平等降低0.003%，从而改善了社会福利。
自2021年以来，托珠单抗用于新冠肺炎治疗提高了人群健康水平，同时改善了健康公平性，因为更多基线健康状况较差的患者有资格接受治疗并获得了更大的相对健康收益。预计未来新冠肺炎住院患者公平获得托珠单抗将导致人群健康持续改善和差距缩小。
