Weighted Lottery to Equitably Allocate Scarce Supply of COVID-19 Monoclonal Antibody.
Weighted Lottery to Equitably Allocate Scarce Supply of COVID-19 Monoclonal Antibody.
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DOI：
10.1001/jamahealthforum.2023.2774
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发表时间：
2023-09-01
期刊：
影响因子：
--
通讯作者：
White, Douglas B.
中科院分区：
文献类型：
--
作者：
McCreary, Erin K.;Essien, Utibe R.;Chang, Chung-Chou H.;Butler, Rachel A.;Pathak, Parag;Soenmez, Tayfun;Uenver, M. Utku;Steiner, Ashley;Chrisman, Maddie;Angus, Derek C.;White, Douglas B.
在一个大型卫生系统中，开发和使用加权彩票来促进稀缺资源向弱势群体的公平分配是否可行？在一项质量改进研究中，通过35个机构的卫生系统中的加权彩票系统检查了450剂tixagevimab与cigavimab的分配，与未加权彩票相比，来自弱势社区的个体在加权彩票中分配药物的比例更高。与未加权过程相比，黑人个体更有可能被分配药物，但与白色个体相比，黑人个体接受分配和接受药物的可能性较低。这项研究的结果表明，加权彩票分配稀缺资源是可行的，可能会导致更多的药物分配给居住在弱势社区的个人，谁确定为黑色的，但是，黑人个人分配的药物可能不太可能接受分配和接收it. Equitable分配稀缺药物是一个重要的卫生政策目标。关于在社区环境中实现公平分配的尝试的数据很少。描述加权抽签的开发和使用，以分配稀缺的tixagevimab和cigavimab作为免疫功能低下个体的COVID-19暴露前预防，并检查这是否促进了弱势人群的公平分配。这项质量改进研究分析了从2021年12月8日至2022年2月23日的加权抽签过程，根据美国地区延迟指数（ADI），在宾夕法尼亚州、纽约和马里兰州的35家医院系统中，将450个tixagevimab和cigavimab剂量的药物分配给居住在高度弱势社区的个体的几率提高了一倍。共有10 834人有资格参加抽签。将加权抽签结果与药物分配后进行的同一队列中的10 000个模拟未加权抽签结果进行比较。分配并接受tixagevimab和cigavimab的弱势社区个体和黑人个体的比例。在10 834名符合条件的个人中，1800人（16.6%）来自贫困社区，767人（7.1%）是黑人。平均（SD）年龄为62.9（18.8）岁，5471例（50.5%）为女性。与未加权彩票相比，来自弱势社区的个体在ADI加权彩票中分配药物的比例更高（29.1% vs 16.6%; P <0.001）。在加权彩票中，黑人个体分配药物的比例更大（9.1%对7.1%; P <0.001）。在ADI加权彩票中分配tixagevimab和cigavimab的450名个体中，与来自其他社区的个体相比，来自弱势社区的个体接受分配并接受药物的比例相似（27.5% vs 27.9%; P = 0.93）。然而，与白色个体相比，分配药物的黑人个体接受药物的可能性较小（41例中的3例[7.3%] vs 402例中的118例[29.4%]; P = .003）。这项质量改进研究的结果表明，ADI加权彩票过程中分配稀缺资源是可行的，在一个大型的卫生系统，并导致更多的药物分配和接收药物的个人谁居住在弱势社区。虽然与未加权的过程相比，ADI加权的彩票也导致更多的药物分配给黑人个体，但与白色个体相比，他们不太可能接受分配并获得分配。需要采取进一步的战略，以确保黑人个人获得分配的稀缺药物。这项质量改进研究考察了使用加权抽签系统将有限剂量的tixagevimab和cigavimab公平分配给弱势群体。
Is development and use of a weighted lottery to promote equitable allocation of scarce resources to disadvantaged populations feasible in a large health system? In a quality improvement study examining the allocation of 450 doses of tixagevimab with cilgavimab through a weighted lottery system in a 35-instiution health system, a higher proportion of individuals from disadvantaged neighborhoods were allocated the drug in the weighted lottery compared with the unweighted lottery. Black individuals were more likely to be allocated the drug compared with an unweighted process but less likely to accept allocation and receive it compared with White individuals. The findings of this study suggest that a weighted lottery to allocate scarce resources is feasible and may result in more drug allocation to individuals who reside in disadvantaged neighborhoods and who identify as Black; however, Black individuals allocated the drug may be less likely to accept allocation and receive it. Equitable allocation of scarce medications is an important health policy goal. There are few data about attempts to achieve equitable allocation in the community setting. To describe the development and use of a weighted lottery to allocate a scarce supply of tixagevimab with cilgavimab as preexposure prophylaxis to COVID-19 for immunocompromised individuals and examine whether this promoted equitable allocation to disadvantaged populations. This quality improvement study analyzed a weighted lottery process from December 8, 2021, to February 23, 2022, that assigned twice the odds of drug allocation of 450 tixagevimab with cilgavimab doses to individuals residing in highly disadvantaged neighborhoods according to the US Area Deprivation Index (ADI) in a 35-hospital system in Pennsylvania, New York, and Maryland. In all, 10 834 individuals were eligible for the lottery. Weighted lottery results were compared with 10 000 simulated unweighted lotteries in the same cohort performed after drug allocation occurred. Proportion of individuals from disadvantaged neighborhoods and Black individuals who were allocated and received tixagevimab with cilgavimab. Of the 10 834 eligible individuals, 1800 (16.6%) were from disadvantaged neighborhoods and 767 (7.1%) were Black. Mean (SD) age was 62.9 (18.8) years, and 5471 (50.5%) were women. A higher proportion of individuals from disadvantaged neighborhoods was allocated the drug in the ADI-weighted lottery compared with the unweighted lottery (29.1% vs 16.6%; P < .001). The proportion of Black individuals allocated the drug was greater in the weighted lottery (9.1% vs 7.1%; P < .001). Among the 450 individuals allocated tixagevimab with cilgavimab in the ADI-weighted lottery, similar proportions of individuals from disadvantaged neighborhoods accepted the allocation and received the drug compared with those from other neighborhoods (27.5% vs 27.9%; P = .93). However, Black individuals allocated the drug were less likely to receive it compared with White individuals (3 of 41 [7.3%] vs 118 of 402 [29.4%]; P = .003). The findings of this quality improvement study suggest an ADI-weighted lottery process to allocate scarce resources is feasible in a large health system and resulted in more drug allocation to and receipt of drug by individuals who reside in disadvantaged neighborhoods. Although the ADI-weighted lottery also resulted in more drug allocation to Black individuals compared with an unweighted process, they were less likely to accept allocation and receive it compared with White individuals. Further strategies are needed to ensure that Black individuals receive scarce medications allocated. This quality improvement study examines the use of a weighted lottery system to allocate a limited number of doses of tixagevimab with cilgavimab equitably to disadvantaged populations.
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影响因子：
39.2
作者：
Kind AJ;Jencks S;Brock J;Yu M;Bartels C;Ehlenbach W;Greenberg C;Smith M
通讯作者：
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DOI：
10.1016/j.lana.2021.100178
发表时间：
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DOI：
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2021-07
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CA: a cancer journal for clinicians
影响因子：
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作者：
Sosa E;D'Souza G;Akhtar A;Sur M;Love K;Duffels J;Raz DJ;Kim JY;Sun V;Erhunmwunsee L
通讯作者：
Erhunmwunsee L
DOI：
10.1016/j.lana.2022.100220
发表时间：
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期刊：
Lancet regional health. Americas
影响因子：
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作者：
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通讯作者：
Momplaisir F