Estimated Health Outcomes and Costs of COVID-19 Prophylaxis With Monoclonal Antibodies Among Unvaccinated Household Contacts in the US

Flaxman, Abraham D.; Issema, Rodal; Barnabas, Ruanne V.; Ross, Jennifer M.

doi:10.1001/jamanetworkopen.2022.8632

Cited by 8 publications

(10 citation statements)

References 22 publications

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“…At the beginning or peak of an epidemic wave, higher infection probabilities can be expected in which mAbs PrEP provision had the most substantial estimated reducing effect on new SARS-CoV-2 infections, admissions, deaths, and health care utilization costs. Similar findings were found within a mAbs postexposure prophylaxis decision analytic modeling study where a larger transmission risk resulted in a greater reduction in COVID-19-related costs . Even if the effectiveness would lower over time, our model still demonstrated a substantial health gain when implemented.…”

Section: Discussionmentioning

confidence: 99%

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Health Outcomes and Cost-effectiveness of Monoclonal SARS-CoV-2 Antibodies as Pre-exposure Prophylaxis

et al. 2023

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ImportancePre-exposure prophylaxis with neutralizing SARS-CoV-2 monoclonal antibodies (mAbs PrEP) prevents infection and reduces hospitalizations and the duration thereof for COVID-19 and death among high-risk individuals. However, reduced effectiveness due to a changing SARS-CoV-2 viral landscape and high drug prices remain substantial implementation barriers.ObjectiveTo assess the cost-effectiveness of mAbs PrEP as COVID-19 PrEP.Design, Setting, and ParticipantsFor this economic evaluation, a decision analytic model was developed and parameterized with health care outcome and utilization data from individuals with high risk for COVID-19. The SARS-CoV-2 infection probability, mAbs PrEP effectiveness, and drug pricing were varied. All costs were collected from a third-party payer perspective. Data were analyzed from September 2021 to December 2022.Main Outcomes and MeasuresHealth care outcomes including new SARS-CoV-2 infections, hospitalization, and deaths. The cost per death averted and cost-effectiveness ratios using a threshold for prevention interventions of $22 000 or less per quality-adjusted life year (QALY) gained.ResultsThe clinical cohort consisted of 636 individuals with COVID-19 (mean [SD] age 63 [18] years; 341 [54%] male). Most individuals were at high risk for severe COVID-19, including 137 (21%) with a body mass index of 30 or higher, 60 (9.4%) with hematological malignant neoplasm, 108 (17%) post-transplantation, and 152 (23.9%) who used immunosuppressive medication before COVID-19. Within the context of a high (18%) SARS-CoV-2 infection probability and low (25%) effectiveness the model calculated a short-term reduction of 42% ward admissions, 31% intensive care unit (ICU) admissions, and 34% deaths. Cost-saving scenarios were obtained with drug prices of $275 and 75% or higher effectiveness. With a 100% effectiveness mAbs PrEP can reduce ward admissions by 70%, ICU admissions by 97%, and deaths by 92%. Drug prices, however, need to reduce to $550 for cost-effectiveness ratios less than $22 000 per QALY gained per death averted and to $2200 for ratios between $22 000 and $88 000.Conclusions and RelevanceIn this study, use of mAbs PrEP for preventing SARS-CoV-2 infections was cost-saving at the beginning of an epidemic wave (high infection probability) with 75% or higher effectiveness and drug price of $275. These results are timely and relevant for decision-makers involved in mAbs PrEP implementation. When newer mAbs PrEP combinations become available, guidance on implementation should be formulated ensuring a fast rollout. Nevertheless, advocacy for mAbs PrEP use and critical discussion on drug prices are necessary to ensuring cost-effectiveness for different epidemic settings.

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Section: Discussionmentioning

confidence: 99%

“…Similar findings were found within a mAbs postexposure prophylaxis decision analytic modeling study where a larger transmission risk resulted in a greater reduction in COVID-19-related costs. 22 Even if the effectiveness would lower over time, our model still demonstrated a substantial health gain when implemented.…”

Section: Discussionmentioning

confidence: 99%

Health Outcomes and Cost-effectiveness of Monoclonal SARS-CoV-2 Antibodies as Pre-exposure Prophylaxis

et al. 2023

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“…Most infusion-related reactions disappear when the infusion is stopped. Although evidence of natural immunity in unvaccinated individuals was present up to 20 months after the COVID-19 infection [ 12 ], the most crucial step to contain the COVID-19 global pandemic is vaccinations to prevent SARS-CoV-2 infections from spreading in communities, to begin with [ 13 ].…”

Section: Discussionunclassified

Use of Casirivimab and Imdevimab for the Treatment of COVID-19

Liu¹,

Mangal²,

Stead³

et al. 2022

Cureus

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The authors present three cases of unvaccinated coronavirus disease 2019 (COVID-19) patients who exhibited symptoms of fever, sore throat, nausea, diarrhea, congestion, and headache. Although they refused COVID-19 vaccination, they presented for the casirivimab and imdevimab monoclonal antibody cocktail, which resulted in the resolution of all symptoms. The authors describe the mechanisms and importance of monoclonal antibody treatment for high-risk and unvaccinated patients infected with SARS-CoV-2.

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“…MS (ES, positive mode): m/z 617 (M + H) + . 1 Methyl (15). Following the general procedure C, compound 10 29 (431 mg, 0.98 mmol), 4cyanophenyldisulfide (175 mg, 0.65 mmol), and I 2 (99 mg, 0.39 mmol) in acetonitrile (2.6 mL) reacted for 4 h. After workup, the crude product was subjected to column chromatography (DCM/ethyl acetate, 70: (16).…”

Section: ■ Conclusionmentioning

confidence: 99%

“…In the case of coronaviruses, the spike protein (S), which protrudes from the viral envelope and gives viruses of this family their characteristic appearance, plays a crucial role in mediating viral entry and represents a key target for recognition by the host immune system. , In SARS-CoV-2, S is a transmembrane glycoprotein that forms homotrimers on the viral membrane and that is cleaved during virus maturation into two subunits, S1 and S2, that remain associated in the viral membrane-bound S trimer. , The receptor binding domain (RBD), located within S1, mediates the binding to the primary host receptor, the human angiotensin converting enzyme 2 (hACE2), while membrane fusion and viral entry are driven by the S2 domain . Antibodies targeting the S protein are able to neutralize the virus, and several monoclonal antibodies have been used for COVID19 treatment, although reduced efficacy has been observed against new variants. , Moreover, antibody-based therapies are costly, prohibiting their application in resource-poor settings. Hence, the use of compounds that can block viral entry represents an attractive antiviral strategy that could synergize with approved therapies to increase therapeutic efficacy, reduce the probability of drug-resistance, and cut down treatment costs.…”

Section: Introductionmentioning

confidence: 99%

C-2 Thiophenyl Tryptophan Trimers Inhibit Cellular Entry of SARS-CoV-2 through Interaction with the Viral Spike (S) Protein

Gargantilla,

Francés,

Adhav

et al. 2023

J. Med. Chem.

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19, by infecting cells via the interaction of its spike protein (S) with the primary cell receptor angiotensin-converting enzyme (ACE2). To search for inhibitors of this key step in viral infection, we screened an in-house library of multivalent tryptophan derivatives. Using VSV-S pseudoparticles, we identified compound 2 as a potent entry inhibitor lacking cellular toxicity. Chemical optimization of 2 rendered compounds 63 and 65, which also potently inhibited genuine SARS-CoV-2 cell entry. Thermofluor and microscale thermophoresis studies revealed their binding to S and to its isolated receptor binding domain (RBD), interfering with the interaction with ACE2. Highresolution cryoelectron microscopy structure of S, free or bound to 2, shed light on cell entry inhibition mechanisms by these compounds. Overall, this work identifies and characterizes a new class of SARS-CoV-2 entry inhibitors with clear potential for preventing and/or fighting COVID-19.

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Estimated Health Outcomes and Costs of COVID-19 Prophylaxis With Monoclonal Antibodies Among Unvaccinated Household Contacts in the US

Cited by 8 publications

References 22 publications

Health Outcomes and Cost-effectiveness of Monoclonal SARS-CoV-2 Antibodies as Pre-exposure Prophylaxis

Health Outcomes and Cost-effectiveness of Monoclonal SARS-CoV-2 Antibodies as Pre-exposure Prophylaxis

Use of Casirivimab and Imdevimab for the Treatment of COVID-19

C-2 Thiophenyl Tryptophan Trimers Inhibit Cellular Entry of SARS-CoV-2 through Interaction with the Viral Spike (S) Protein

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