Comparison of allocation strategies of convalescent plasma to reduce excess infections and mortality from SARS-CoV-2 in a US-like population.
Comparison of allocation strategies of convalescent plasma to reduce excess infections and mortality from SARS-CoV-2 in a US-like population.
复制标题
比较恢复期血浆分配策略以减少类似美国人群中 SARS-CoV-2 的过度感染和死亡率。
作者：
Kostandova,Natalya;Drabo,EmmanuelFulgence;Yenokyan,Karine;Wesolowski,Amy;Truelove,Shaun;Bloch,EvanM;Tobian,AaronAR;Vassallo,RalphR;Bravo,MarjorieD;Casadevall,Arturo;Lessler,Justin;Lau,Bryan
虽然在正在进行的COVID - 19大流行中使用恢复期血浆（CP）的情况不一致，但CP有可能在未来的大流行中降低过高的发病率和死亡率。鉴于对CP供应的限制，必须围绕CP的分配做出决策。研究设计和方法使用离散时间随机区室模型，我们模拟了四种可能的分配策略的实施：对早期住院的COVID - 19患者给予CP；对门诊病人进行CP治疗；对住院患者使用CP，对门诊患者使用剩余CP，在两种情况下使用CP，同时优先考虑门诊患者。我们检查了180天内每种分配方案下SARS - CoV - 2感染的最终规模、高峰和累计住院人数以及累计死亡人数。我们比较了每种策略下的加权健康效益成本。结果优先给药早期住院患者，剩余血浆在门诊给药，死亡率降低幅度最大，比单独给药住院患者平均多避免15%的COVID - 19死亡（95% CI[11%-18%]）。优先给门诊患者，剩余血浆给住院患者，避免住院的比例最高（比单独给住院患者高22%[21%-23%]）。讨论恢复期血浆分配策略应根据避免死亡、感染或住院的相对优先级来确定。在考虑的条件下，混合分配策略（将CP分配给门诊和住院患者）比在单一环境下使用CP导致更大的感染和死亡避免百分比。
BackgroundWhile the use of convalescent plasma (CP) in the ongoing COVID‐19 pandemic has been inconsistent, CP has the potential to reduce excess morbidity and mortality in future pandemics. Given constraints on CP supply, decisions surrounding the allocation of CP must be made.Study Design and MethodsUsing a discrete‐time stochastic compartmental model, we simulated implementation of four potential allocation strategies: administering CP to individuals in early hospitalization with COVID‐19; administering CP to individuals in outpatient settings; administering CP to hospitalized individuals and administering any remaining CP to outpatient individuals and administering CP in both settings while prioritizing outpatient individuals. We examined the final size of SARS‐CoV‐2 infections, peak and cumulative hospitalizations, and cumulative deaths under each of the allocation scenarios over a 180‐day period. We compared the cost per weighted health benefit under each strategy.ResultsPrioritizing administration to patients in early hospitalization, with remaining plasma administered in outpatient settings, resulted in the highest reduction in mortality, averting on average 15% more COVID‐19 deaths than administering to hospitalized individuals alone (95% CI [11%–18%]). Prioritizing administration to outpatients, with remaining plasma administered to hospitalized individuals, had the highest percentage of hospitalizations averted (22% [21%–23%] higher than administering to hospitalized individuals alone).DiscussionConvalescent plasma allocation strategy should be determined by the relative priority of averting deaths, infections, or hospitalizations. Under conditions considered, mixed allocation strategies (allocating CP to both outpatient and hospitalized individuals) resulted in a larger percentage of infections and deaths averted than administering CP in a single setting.