Can Monoclonal Antibodies Prevent COVID-19? Assessing Cost-Effectiveness in a High-Risk Population

Pre-exposure prophylaxis (PrEP) using neutralizing SARS-CoV-2 monoclonal antibodies (mAbs) has shown promise in preventing COVID-19 infections among high-risk individuals. However, barriers such as changing viral landscape and high drug prices hinder its effectiveness and implementation.

One study, published this week in JAMA Network Open, aimed to evaluate the cost-effectiveness of mAbs PrEP as a preventive strategy for COVID-19. The investigators ensured their research included a population at high risk for severe or fatal COVID-19 outcomes.

The economic evaluation was conducted using a decision analytic model, incorporating health outcomes and utilization data from high-risk individuals. Variables included COVID-19 infection probability, mAbs PrEP effectiveness, and drug pricing. Costs were analyzed from a third-party payer perspective.

Health care outcomes, including new infections, hospitalizations, and deaths, were assessed from September 2021–December 2022. The study calculated cost per death averted and cost-effectiveness ratios based on a threshold of $22,000 or less per quality-adjusted life year (QALY) gained.

The clinical cohort included 636 individuals with COVID-19, averaging 63 years of age and 54% male. Most of whom were at high risk for severe disease; 21% had a body mass index (BMI) of 30 or higher, 9.4% had hematological malignant neoplasm, 17% post-transplantation, and 23.9% used immunosuppressive medication before COVID-19.

The model demonstrated a short-term reduction in ward admissions, ICU admissions, and deaths by 42%, 31%, and 34%, respectively, with a high infection probability (18%) and low effectiveness (25%). Cost-saving scenarios were achieved with mAbs PrEP prices of $275 and effectiveness of 75% or higher.

At 100% effectiveness, mAbs PrEP could reduce ward admissions by 70%, ICU admissions by 97%, and deaths by 92%. However, drug prices needed to be reduced to $550 for cost-effectiveness ratios below $22,000 per QALY gained per death averted.

The study suggests that mAbs PrEP can be cost saving at the beginning of an epidemic wave with high effectiveness and lower drug prices. The investigators emphasized that these findings are crucial for decision-makers involved in mAbs PrEP implementation. As newer mAbs PrEP combinations emerge, guidance should be developed for their rapid rollout. Advocacy for mAbs PrEP use and discussions on drug prices are vital to ensure cost-effectiveness across different epidemic settings.