The Impact of Funding Tocilizumab for the Inpatient Treatment of COVID-19 in the United States: A Distributional Cost-Effectiveness Analysis

OBJECTIVES: A distributional cost-effectiveness analysis (DCEA) evaluates how tocilizumab versus standard of care for inpatient treatment of COVID-19 from 2021 to 2023 impacted health equity in the United States (US).

METHODS: A published payer perspective DCEA for inpatient COVID-19 treatments was adapted to include information on baseline health disparities across 25 equity-relevant subgroups based on race/ethnicity (5 census-based groups) and county-level social vulnerability (5 geographic quintiles). The underlying cost-effectiveness model was updated to reflect tocilizumab efficacy, contemporary unit costs, patient characteristics at admission, and standard of care outcomes. DCEA inputs for COVID-19 hospitalization and subgroup risk adjustments based on county-level social vulnerability index scores were derived from published estimates. Opportunity costs were estimated by converting total tocilizumab spend into quality-adjusted life-years (QALYs) using an equal distribution of opportunity costs across subgroups. Sensitivity analyses examined changes in tocilizumab utilization, social vulnerability risk adjustments, inequality aversion, and opportunity cost thresholds.

RESULTS: Tocilizumab treatment was cost-effective across 25 equity-relevant subgroups, but resulted in larger relative QALY gains in more socially vulnerable subgroups given higher hospitalization rates and inpatient mortality. Using an opportunity cost threshold of $150,000/QALY and Atkinson of 11, tocilizumab is 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. Conclusions were robust across all levels of inequality aversion and opportunity cost thresholds. Impact on social welfare was driven primarily by tocilizumab utilization and social vulnerability risk adjustments.

CONCLUSIONS: 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, and received larger relative health gains, from treatment. Future equitable access to tocilizumab for eligible COVID-19 patients is expected to lead to continued increases in population health and reductions in existing health disparities.