Clinical and Economic Impact of Pre-Exposure Prophylaxis With Tixagevimab+Cilgavimab in 2022 in Switzerland to Protect Immunocompromised Individuals

Speaker(s)

Rivolo S1, Bungey G2, Morris W3, Nagy E4, Williams S5, Maillat L6, Jańska A7, Arnetorp S8
1Evidera, a part of Thermo Fisher Scientific, San Felice Segrate, MI, Italy, 2Evidera, a part of Thermo Fisher Scientific, London, London, UK, 3Evidera, a part of Thermo Fisher Scientific, Cambridge, Cambridgeshire, UK, 4Evidera, a part of Thermo Fisher Scientific, Liverpool, Merseyside, UK, 5AstraZeneca, Zurich, Zurich, Switzerland, 6AstraZeneca, Lausanne, Vaud, Switzerland, 7AstraZeneca, Cambridge, Cambridgeshire, UK, 8AstraZeneca, Gothenberg, Västergötland, Sweden

Presentation Documents

OBJECTIVES: The risk of severe COVID-19 (hospitalisation or death) during the Omicron waves remains significant in immunocompromised individuals (ICIs), despite vaccine boosters. Passive immunisation through pre-exposure prophylaxis (PrEP) can protect ICIs. This analysis uses tixagevimab+cilgavimab, made available in May 2022 in Switzerland, as a case study to quantify the clinical and economic impact of PrEP and compares it to alternative scenarios (broader ICI coverage, earlier access or both).

METHODS: A combined decision tree–Markov model evaluated health and economic outcomes of introducing tixagevimab+cilgavimab in Switzerland in May 2022 and compared it to different hypothetical scenarios. The “real-life” scenario considered 6-month protection of one tixagevimab+cilgavimab dose with 15% uptake among 10,000 PrEP-eligible ICIs (13% 6-month infection risk). Hypothetical scenarios: 1) Broader coverage (one dose, 100% uptake, 13% 1-year infection risk), 2) Earlier access (two doses, 15% uptake, 30% 1-year infection risk) and 3) Broader coverage and earlier access (two doses, 100% uptake, 30% 1-year infection risk). Model inputs were informed by Omicron-specific literature. Extensive sensitivity analyses were conducted.

RESULTS: Real-life scenario: tixagevimab+cilgavimab prevented 147 symptomatic cases (saved Swiss Francs [CHF] 434,939), 13 hospitalisations (CHF 284,993), 119 bed days (CHF 186,412) and 28 post-acute COVID-19 cases (CHF 209,469). Earlier access or broader ICI coverage would have prevented 2.3 and 6.7 times more COVID-19–related outcomes and healthcare-related costs, respectively. Both combined would have prevented 15.5 times more COVID-19–related outcomes (2280 symptomatic cases, 210 hospitalisations, 1848 bed days and 442 post-acute COVID cases), with CHF 2,894,988–6,754,608 potential saving in healthcare-specific resources.

CONCLUSIONS: Tixagevimab+cilgavimab significantly reduced the COVID-19 disease burden in ICIs in Switzerland upon introduction in May 2022. However, tixagevimab+cilgavimab impact could have been more substantial with more timely access and broader ICI coverage. This should be considered when designing future strategies to optimally protect the immunocompromised population.

Funding: AstraZeneca

Code

EE29

Topic

Economic Evaluation

Topic Subcategory

Budget Impact Analysis, Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas