Kalil Andre C, Chandak Aastha, Moore Luke S P, Ahuja Neera, Kolditz Martin, Casciano Roman, Kadambi Ananth, Yaghoubi Mohsen, Tsiodras Sotirios, Malin Jakob J, Mozaffari Essy, Bartoletti Michele
Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Evidence and Access, Certara, New York, New York, USA.
Clin Infect Dis. 2024 Dec 13;79(Suppl 4):S160-S166. doi: 10.1093/cid/ciae517.
As coronavirus disease 2019 (COVID-19)-related mortality remains a concern, optimal management of patients hospitalized for COVID-19 continues to evolve. We developed a population model based on real-world evidence to quantify the clinical impact of increased utilization of remdesivir, the effectiveness of which has been well established in hospitalized patients with COVID-19.
The PINC AI healthcare database records for patients hospitalized for COVID-19 from January to December 2023 were stratified by those treated with or without remdesivir ("RDV" and "no RDV") and by supplemental oxygen requirements: no supplemental oxygen charges (NSOc), low-flow oxygen (LFO), and high-flow oxygen/non-invasive ventilation. Key vulnerable subgroups such as elderly and immunocompromised patients were also evaluated. The model applied previously published hazard ratios (HRs) to 28-day in-hospital mortality incidence to determine the number of potential lives saved if additional no RDV patients had been treated with remdesivir upon hospital admission.
Of 84 810 hospitalizations for COVID-19 in 2023, 13,233 no RDV patients were similar in terms of characteristics and clinical presentation to the RDV patients. The model predicted that initiation of remdesivir in these patients could have saved 231 lives. Projected nationally, this translates to >800 potential lives saved (95% confidence interval, 469-1126). Eighty-nine percent of potential lives saved were elderly and 19% were immunocompromised individuals. Seventy-six percent were among NSOc or LFO patients.
This public health model underscores the value of initiating remdesivir upon admission in patients hospitalized for COVID-19, in accordance with evidence-based best practices, to minimize lives lost because of severe acute respiratory syndrome coronavirus 2 infection.
由于2019冠状病毒病（COVID-19）相关死亡率仍是一个令人担忧的问题，COVID-19住院患者的最佳管理方法仍在不断发展。我们基于真实世界证据开发了一个人群模型，以量化增加使用瑞德西韦的临床影响，瑞德西韦在COVID-19住院患者中的有效性已得到充分证实。
PINC AI医疗数据库记录了2023年1月至12月因COVID-19住院的患者，根据是否接受瑞德西韦治疗（“RDV”和“未接受RDV”）以及补充氧气需求进行分层：无补充氧气费用（NSOc）、低流量氧气（LFO）和高流量氧气/无创通气。还评估了老年和免疫功能低下等关键脆弱亚组。该模型将先前公布的风险比（HRs）应用于28天住院死亡率发生率，以确定如果更多未接受RDV治疗的患者在入院时接受瑞德西韦治疗，可能挽救的生命数量。
在2023年84810例COVID-19住院病例中，13233例未接受RDV治疗的患者在特征和临床表现方面与接受RDV治疗的患者相似。该模型预测，在这些患者中开始使用瑞德西韦可挽救231条生命。在全国范围内进行预测，这意味着可挽救超过800条潜在生命（95%置信区间，469-1126）。挽救的潜在生命中有89%为老年人，19%为免疫功能低下者。76%的潜在生命挽救发生在NSOc或LFO患者中。
该公共卫生模型强调了根据循证最佳实践，在COVID-19住院患者入院时开始使用瑞德西韦的价值，以尽量减少因严重急性呼吸综合征冠状病毒2感染而导致的生命损失。
