The impact of vaccination and outpatient treatment on the economic burden of Covid-19 in the United States omicron era: a systematic literature review

2023-2024 COVID-19 vaccine uptake among immunocompromised individuals in two US states

BACKGROUND

Uptake of COVID-19 vaccines has declined over time, however, little data exist describing uptake among the immunocompromised who remain at high risk of severe disease. We evaluated XBB COVID-19 vaccine uptake during the 2023-2024 season among immunocompromised persons who had previously received a COVID-19 vaccine in two large, diverse US states.

METHODS

Using data from state vaccine registries linked to insurance claims, we conducted a retrospective cohort study among individuals ≥6 months of age living in California or Louisiana as of September 11, 2023 who (1) had continuous pharmacy and medical enrollment in an insurance plan reported by HealthVerity, (2) met the Centers for Disease Control and Prevention criteria for moderately or severely immunocompromised (HIV/AIDS or primary immunodeficiency, hematologic malignancy in the prior year, solid organ or bone marrow transplant in the prior two years, or use of immunosuppressive therapy in the prior 210 days), and (3) previously received at least one dose of COVID-19 vaccine. We calculated the cumulative incidence of 2023-2024 COVID-19 vaccine receipt through March 31, 2024, stratified by state, age group, and specific immunocompromising condition.

RESULTS

A total of 321,896 (median age 55 years; 57 % female) and 43,250 (median age 45 years; 64 % female) immunocompromised individuals met selection criteria in California and Louisiana, respectively. In both states, the most common immunocompromising category was the use of immunosuppressive therapy (78 % and 85 % of individuals in California and Louisiana, respectively). Only 21 % of individuals in California and 6 % of individuals in Louisiana received a 2023-2024 COVID-19 vaccine by March 31, 2024. Uptake was similar across immunocompromising conditions.

DISCUSSION

During the 2023-2024 respiratory virus season, COVID-19 vaccine uptake among the immunocompromised in these 2 states was low, with fewer than 21 % receiving a 2023-2024 dose. Enhanced efforts to increase COVID-19 vaccine uptake in this vulnerable population are needed.

Efficacy and safety of antiviral treatments for symptomatic COVID-19 outpatients: network meta-analysis and budget impact analysis

Introduction

Remdesivir (RDV) and nirmatrelvir/ritonavir (NRM/RTV) are two antiviral agents for treating outpatient adults with mild to moderate symptomatic COVID-19 at high risk of developing a severe disease. The review objectives are to compare the efficacy and safety of these antivirals based on published RCT and real-world data, and to evaluate costs from a healthcare perspective.

Methods

This study provides a network meta-analysis of RDV and NRM/RTV for early treatment of COVID-19. The outcomes analysed were hospitalisation for any cause and serious adverse events. A cost-analysis was performed incorporating drug costs, administration, hospitalisations, and management of adverse events. A budget impact analysis was estimated for the University Hospital of Padua.

Results

Our results indicated that RDV showed a trend towards a lower risk of hospitalisation compared to NRM/RTV (RR 1.59, 95% CI: 0.60-4.20), though this was not statistically significant. For safety, NRM/RTV demonstrated a slightly lower risk of serious adverse events compared to RDV (RR 0.92, 95% CI: 0.31-2.74), but without statistical significance. A cost analysis showed that NRM/RTV could save €550,854.46 per 1,000 patients. Finally, a budget impact analysis based on data from the University Hospital of Padua estimated annual savings of €210,977.25 if all early treatments were administered with NRM/RTV instead of RDV.

Discussion

The comparison of the two antiviral therapies for the early treatment of COVID-19 did not yield statistically significant differences in the potential efficacy and safety to prevent hospitalisation or serious adverse events. However, the results of the cost-analysis showed a saving in favour of NRM/RTV.

Cardiac symptoms in patients 3-6 months after contracting COVID-19- data from the polish STOP-COVID registry

BACKGROUND

Common complaints of long COVID patients are cardiac symptoms such as fatigue, weakness, and a feeling of palpitations. The study aimed to investigate the clinical features of patients with persistent cardiological symptoms occurring within 3 to 6 months after COVID-19. Differences in ambulatory blood pressure monitoring (ABPM), Holter ECG (electrocardiogram) and Echocardiography between people with and without persistent cardiological symptoms were evaluated. We also assessed whether the symptoms of anxiety and depression may be implicated in the clinical outcomes.

MATERIALS AND METHODS

This was a retrospective study of patients affiliated with the STOP-COVID registry who attended a follow-up visit 3-6 months after undergoing COVID-19. The visit assessed the clinical symptoms present and performed tests: ABPM, Holter ECG and Echocardiography. 504 patients additionally had GAD-2 (Generalized Anxiety Disorder 2-item) and PHQ-2 (Patient Health Questionnaire-2) tests performed.

RESULTS

The analysis included 1080 patients. At least 1 of the analyzed symptoms was present in 586 patients (54.3%). The most common symptom was fatigue (38.9%). Comparing patients with or without palpitations showed that the mean value of ventricular extrasystole was higher in the former group (p = 0.011). Comparing patients with and without cardiac symptoms, there were differences in the mean values of the PHQ-2 (p = 0.022) and GAD-2 (p < 0.001) scales, as well as in the percentage of responses related to the risk of anxiety or depression.

CONCLUSION

Cardiological symptoms are common among health issues that patients must face after contracting COVID-19. People with palpitations had more excessive ventricular extrasystoles than patients without these symptoms.

TRIAL REGISTRATION

Our retrospective study was based on analysis of medical data of patients with COVID-19 treated on out-patient basis in the STOP-COVID registry of the Polish Long-Covid Cardiovascular (PoLoCOV-CVD) study (ClinicalTrials.gov identifier- NCT05018052, the registration date 29.05.2020). Consent to conduct the study was obtained from the Bioethics Committee of the District Medical Chamber in Lodz (no. KB-0115/2021).

Antiviral Use in Mild-to-Moderate SARS-CoV-2 Infections during the Omicron Wave in Geriatric Patients

(1) Background: Geriatric patients are at high risk of complications of Coronavirus disease-2019 (COVID-19) and are good candidates for antiviral drugs. (2) Methods: A retrospective study of electronic health records (EHRs) aiming to describe antiviral (nirmatrelvir and ritonavir (nirmatrelvir/r) or remdesivir) use, drug-drug interactions (DDIs) and adverse drug reactions (ADRs) in elderly patients (75 and over), hospitalized with mild-to-moderate COVID-19 between July 2022 and June 2023. (3) Results: Out of 491 patients (mean age: 86.9 years), 180 (36.7%) received nirmatrelvir/r, 78 (15.9%) received remdesivir, and 233 (47.4%) received no antiviral therapy. No association was found between the choice of antiviral and the demographic or medical data. No serious ADR was observed. Nirmatrelvir/r dosage adjustment was inadequate in 65% of patients with renal impairment. In total, 128 patients (71%) on nirmatrelvir/r had potential pharmacokinetic DDIs, with 43 resulting in a possibly related ADR. In the remdesivir group, pharmacodynamic DDIs were more frequent, with QTc prolongation risk in 56 patients (72%). Only 20 patients underwent follow-up ECG, revealing QTc prolongation in 4. (4) Conclusions: There is an underutilization of antivirals despite their justified indications. Nirmatrelvir/r dosage was rarely adjusted to renal function. Dose adjustments and closer monitoring are needed due to the high risk of drug interactions.

Long COVID outcomes following omicron wave in non-hospital population

Background

The persistence of symptoms or the development of new symptoms following a diagnosis of SARS-CoV-2 has given rise to a multifaceted clinical condition referred to as "long COVID" (LC). The understanding of LC among China's non-hospitalized population continues to be insufficient. This investigation was designed to evaluate the protracted consequences amongst this demographic, as well as to identify the associated risk factors.

Methods

This research constitutes a prospective cohort study focusing on non-hospitalized individuals, aged between 18 and 59, who have been positively diagnosed with COVID-19. Each participant was subjected to a sequence of questionnaire-based surveys, designed to evaluate symptoms as well as the status of depression and anxiety. A logistic regression model, adjusted for multiple variables, was employed to scrutinize the correlation between demographic elements, lifestyle attributes, and health-related risk factors in relation to conditions and symptoms post COVID-19 infection.

Results

A total of 706 individuals participated in the 3 months follow-up, with 620 continuing on to the 6 months follow-up. The median age was 35 (28, 43) years, and 597 (85%) are female. Upon follow-up, Compared with patients without LC, patients with LC have a higher proportion of females (420 (87%) vs. 177 (79%); p = 0.010), were older (35 (29, 44) years vs. 33 (27, 41) years; p = 0.010) and have more comorbidities. Out of all participants, 483 (68.4%) reported experiencing at least one symptom at the 3 months mark, while 49.7% reported symptoms persisting at the 6 months mark. At the 3 months follow-up, the most prevalent persistent symptoms were cough (46%), fatigue (38%), and shortness of breath (34%). By the 6 months follow-up, fatigue (25%), shortness of breath (22%), and sleep disorders (16%) were the most commonly reported symptoms. Anxiety and depression were consistently reported as prevalent symptoms throughout the follow-up period. Most patient symptoms fade over time, with the quickest decreases observed in cough (from 46 to 9%), expectoration (from 26 to 6.3%), smell disorder (from 16 to 3.9%), and taste disorder (from 18 to 3.5%). Male and those possessing advanced educational qualifications exhibit a decreased susceptibility to the sustained incidence of coughing. Conversely, older age and the presence of comorbidities were identified as risk factors for persistent fatigue and shortness of breath.

Conclusion

In the after of COVID-19, it has been observed that the majority of patient symptoms tend to decrease over time. The primary residual symptoms noticed after a 6 month follow-up were fatigue, dyspnea, and sleep disturbances. However, it's noteworthy that the risk factors associated with these symptoms exhibit subtle variations. Furthermore, psychological sequelae, namely depression and anxiety, are frequently reported among COVID-19 survivors.