Kuritzkes, Daniel R.

Abstract Purpose SARS-CoV-2 infection continues to impact global health, particularly among high-risk vulnerable individuals. With the loss of federal funding for SARS-CoV-2 management, hospitals will need to budget appropriately for antivirals like remdesivir, which has demonstrated effectiveness in reducing mortality. We evaluated the economic impact realized by hospitals for patients hospitalized for SARS-CoV-2 infection and initiated on remdesivir therapy. Methods We conducted a retrospective analysis using data compiled in the Premier Healthcare Database from January 2023 to February 2024. Propensity score matching was used to compare remdesivir-treated (RDV) and untreated (No RDV) groups. The mortality rate, hazard ratios associated with remdesivir use, and hospitalization costs were assessed overall and among the elderly (age ≥65 years). We also conducted a cost-effectiveness analysis to assess the economic value of remdesivir treatment. Results Among 25,498 hospitalized patients, the mortality rate in the RDV group was lower than in the No RDV group (6.2% versus 8.1%), with a greater reduction in the elderly (6.9% versus 9.0%). Remdesivir significantly reduced mortality risk by approximately 25% overall and among the elderly. Each life saved was realized at a minimal increase in average hospitalization costs ($18,329 in the RDV group versus $14,845 in the No RDV group). Remdesivir was a cost-effective treatment option at a willingness-to-pay threshold of $25,000 overall and among the elderly. Conclusions Our evaluation provides contemporaneous evidence of benefits and costs associated with management of individuals hospitalized for SARS-CoV-2 infection. Initiation of remdesivir was associated with minimal incremental hospitalization costs for lives saved as compared to not initiating remdesivir. Hospital pharmacy leadership can utilize this real-world evidence to appropriately budget for remdesivir treatment.

Abstract Background The US Centers for Disease Control and Prevention recommends HIV testing every 3 months in oral PrEP users. We performed a national assessment of HIV testing compliance among oral PrEP users. Methods We analyzed 408 910 PrEP prescriptions issued to 39 809 PrEP users using a national insurance claims database that contained commercial and Medicaid claims. We identified PrEP use based on pharmacy claims and outpatient diagnostic coding. We evaluated the percentage of PrEP prescription refills without HIV testing (identified by CPT codes) within the prior 3, 6, and 12 months using time to event methods. We performed subgroup and multivariate analyses by age, gender, race, insurance type, and geography. Results Of 39 809 persons, 36 197 were commercially insured, 3612 were Medicaid-insured, and 96% identified as male; the median age (interquartile range) was 34 (29–44) years, and the Medicaid-insured PrEP users were 24% Black/African American, 44% White, and 9% Hispanic/Latinx. Within the prior 3, 6, and 12 months, respectively, the percentage of PrEP prescription fills in individuals without HIV Ag/Ab testing was 34.3% (95% CI, 34.2%–34.5%), 23.8% (95% CI, 23.7%–23.9%), and 16.6% (95% CI, 16.4%–16.7%), and the percentage without any type of HIV test was 25.8% (95% CI, 25.6%–25.9%), 14.6% (95% CI, 14.5%–14.7%), and 7.8% (95% CI, 7.7%–7.9%). Conclusions Approximately 1 in 3 oral PrEP prescriptions were filled in persons who had not received an HIV Ag/Ab test within the prior 3 months, with evidence of health disparities. These findings inform clinical PrEP monitoring efforts and compliance with national HIV testing guidance to monitor PrEP users.