Monoclonal Antibodies as Pre-exposure Prophylaxis May Be Cost-Effective Approach to Reduce Severe Outcomes in COVID-19

Pre-exposure prophylaxis (PrEP) with long-acting and neutralizing SARS-CoV-2 monoclonal antibodies (mAbs) may prevent SARS-CoV-2 infection at a cost-saving outcome; however, current drug prices must still be adjusted to maintain the cost-effective ratio, according to the results of a study published in JAMA Network Open. Use of mAbs PrEP was cost-saving for people at high risk of severe COVID-19 if the cost was $275 and showed a minimum efficacy of 75%.

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Currently, tixagevimab-cilgavimab is the only form of mAb PrEP that is available to prevent or reduce the risk of severe COVID-19. Investigators conducted a study using a decision analytical model to understand the short-term health outcomes of patients at high-risk for severe COVID-19 who received mAbs PrEP. They also evaluated the treatment’s cost-effectiveness.

The analytical model included data from 636 patients (mean [SD] age 63 [18] years; 341 [54%] male) with SARS-CoV-2 who are part of the ongoing TURN-COVID study. Most patients were at risk of severe COVID-19, with risk factors including body mass index of 30 or more, hematological malignant neoplasm, post-transplantation, and being on immunosuppressive medication prior to infection.

mAbs PrEP was shown to have a more substantial impact on reducing new infections, hospital admissions, deaths, and utilization costs in health care in times with increased risk of infection at the beginning or peak of the epidemic wave, according to the study results. Among hospitalized patients, fewer people needed additional antiviral therapies (lowering cost), and patients had lower disease duration.

Because the most expensive patient category associated with SARS-CoV-2 infection is intensive care unit (ICU) costs during first 90 days of infection—having an average cost of $39,313—reducing ICU admittance and costs could further mitigate the economic burden, according to the study.

The data even suggest that mAbs PrEP would be cost-effective at $550 if the efficacy were only 25%, with the caveat that the cost-effective ratio is less than $22,000 per quality-adjusted life year (QALY) gained per death averted. Treatment price would have to be $2200 if the cost-effectiveness ratio were to sit between $22,000 and $88,000 per QALY gained per death averted.

Limitations of the study included that at times, there was missing self-completed data collection; the study population was heterogeneous; there is possible recall bias; and investigators did not take reinfection costs into account.

Overall, the authors said the findings illuminate that the price of treatment with lower efficacy should be reduced to reflect the quality. They added that mABs as PrEP for COVID-19 should be implemented as a possible cost-saving management strategy to reduce the risk of severe disease burden.

“Even if the effectiveness would lower over time, our model still demonstrated a substantial health gain when implemented,” the study authors wrote. “Drug prices should therefore be further negotiated with the advocacy of governments and patient organizations.”

Reference

Popping S, Nichols B, Appelman B, et al. Health Outcomes and Cost-effectiveness of Monoclonal SARS-CoV-2 Antibodies as Pre-exposure Prophylaxis JAMA Netw Open. 2023;6(7):e2321985. doi:10.1001/jamanetworkopen.2023.21985