J Korean Med Sci.  2023 Aug;38(32):e250. 10.3346/jkms.2023.38.e250.

A Model-Based Cost-Effectiveness Analysis of Long-Acting Monoclonal Antibody (Tixagevimab and Cilgavimab: Evusheld) Preventive Treatment for High-Risk Populations Against SARSCoV-2 in Korea

• Jo Y
• Kim SB
• Jung J

• KMID: 2545202
• DOI: http://doi.org/10.3346/jkms.2023.38.e250

Abstract

Background
Tixagevimab and cilgavimab (Evusheld) administration is a recommended strategy for unvaccinated patients with immunocompromised conditions and severe allergic reaction conditions to protect high-risk individuals and control the coronavirus disease 2019 (COVID-19) epidemic. We estimated the cost-effectiveness of Evusheld in key risk populations: 1) immunocompromised (vaccinated/unvaccinated), 2) severe allergic reaction, and 3) unvaccinated elderly high-risk groups.
Methods
Based on the estimated target risk group population, we used a model of COVID-19 transmission to estimate the size of the risk group population for whom Evusheld treatment may help prevent symptomatic COVID-19 (and deaths) in 2022. We projected Evusheld intervention costs, quality-adjusted life year (QALY) lost, cost averted and QALY gained by reduced COVID-19 incidence, and incremental cost-effectiveness (cost per QALY gained) in each modeled population from the healthcare system perspective.
Results
Our study demonstrated that Evusheld treatment for COVID-19 infection in South Korea is highly cost-effective for unvaccinated risk groups ($18,959 per QALY gained for immunocompromised and $23,978 per QALY gained for high-risk elderly groups) and moderately cost-effective among individuals who are vaccinated immunocompromised ($46,494 per QALY gained), or have severe allergic reactions ($45,996 per QALY gained). Evusheld’s cost-effectiveness may be subject to risk-group-specific COVID-19 disease progression and Evusheld efficacy and cost, which may change in future epidemic scenarios.
Conclusion
As the COVID-19 variants and risk group-specific durable efficacy, toxicity (and/ or resistance) and optimal dosing of Evusheld remain uncertain, better empirical estimates to inform these values in different epidemiological contexts are needed. These results may help decision-makers prioritize resources toward more equitable and effective COVID-19 control efforts.

Keyword

SARS-Cov-2; COVID-19; Cost-Effectiveness Analysis; Evusheld

Figure

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  Fig. 1 One-way sensitivity analyses with the baseline incremental cost-effectiveness ratio.COVID-19 = coronavirus disease 2019.

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  Fig. 2 Three-way sensitivity analyses with the baseline incremental cost-effectiveness ratio.

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  Fig. 3 Probability of cost-effectiveness. Vaccinated-immunocompromised ‘sub’ indicates the subgroup (about 10%) of total vaccinated immunocompromised group as initial target group determined by supply condition.QALY = quality-adjusted life year.

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