Chen Siyu, Venkatesan Sudhir, Arnetorp Sofie, Bergenheim Klas, Dube Sabada, Meeraus Wilhelmine, Ferreira Cátia, Taylor Sylvia, White Lisa J
Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America.
Medical and Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom.
PLoS Comput Biol. 2025 Jun 2;21(6):e1013072. doi: 10.1371/journal.pcbi.1013072. eCollection 2025 Jun.
Many immunocompromised individuals mount inadequate immune responses following COVID-19 vaccination, thus relying on other social distancing behaviours, particularly shielding, for protection, impacting their quality of life. However, little is known about historical/current levels and effectiveness of shielding or factors influencing individuals' decision to continue shielding. Long-acting antibody pre-exposure prophylaxis (LAAB-PrEP) provides direct protection against COVID-19 in immunocompromised individuals who have been and may continue to shield. However, the proportion and incidence of circulating variants for which LAAB-PrEP would be effective is unpredictable. Given this uncertain behavioural and immuno-epidemiological context, we developed a modelling framework to explore features that most impact health outcomes and cost effectiveness of long-term administration of LAAB-PrEP against COVID-19 infection in immunocompromised individuals in the English context. The model predicted that the incremental cost-effectiveness ratio (ICER) of LAAB-PrEP against COVID-19 in immunocompromised individuals will be largely driven by features of utility of shielding, current/future shielding behaviour, cost of shielding, risk of COVID-19 hospitalisation among immunocompromised individuals and the time horizon used for the cost-effectiveness analysis. The model estimated that for realistic ranges of influential factors, it is possible for LAAB-PrEP to be cost effective under the conditions that most immunocompromised individuals would shield indefinitely if it were not available but would switch to LAAB-PrEP if it were. Thus, if individuals stop shielding when taking LAAB-PrEP, then LAAB-PrEP is cost effective.
许多免疫功能低下的个体在接种新冠疫苗后免疫反应不足，因此依赖其他社交距离措施，特别是自我隔离来保护自己，这影响了他们的生活质量。然而，对于自我隔离的历史/当前水平和有效性，或影响个体继续自我隔离决定的因素，我们知之甚少。长效抗体暴露前预防（LAAB-PrEP）为已经进行且可能继续进行自我隔离的免疫功能低下个体提供了针对新冠病毒的直接保护。然而，LAAB-PrEP有效的循环变异株的比例和发生率是不可预测的。鉴于这种行为和免疫流行病学背景的不确定性，我们开发了一个建模框架，以探索在英国背景下，对免疫功能低下个体长期使用LAAB-PrEP预防新冠病毒感染的健康结果和成本效益影响最大的特征。该模型预测，免疫功能低下个体使用LAAB-PrEP预防新冠病毒的增量成本效益比（ICER）将在很大程度上由自我隔离的效用特征、当前/未来的自我隔离行为、自我隔离成本、免疫功能低下个体中新冠病毒住院风险以及成本效益分析所使用的时间范围决定。该模型估计，对于有影响的因素的实际范围，如果没有LAAB-PrEP，大多数免疫功能低下个体将无限期自我隔离，但如果有LAAB-PrEP，他们会转而使用，在这种情况下，LAAB-PrEP有可能具有成本效益。因此，如果个体在服用LAAB-PrEP时停止自我隔离，那么LAAB-PrEP就是具有成本效益的。
