Features influencing the health and economic impact of preventing COVID-19 in immunocompromised individuals

Many immunocompromised individuals mount inadequate immune responses following COVID-19 vaccination, thus relying on other social distancing behaviours, particularly shielding, for protection, impacting their quality of life. However, little is known about historical/current levels and effectiveness of shielding or factors influencing individuals' decision to continue shielding. Long-acting antibody pre-exposure prophylaxis (LAAB-PrEP) provides direct protection against COVID-19 in immunocompromised individuals who have been and may continue to shield. However, the proportion and incidence of circulating variants for which LAAB-PrEP would be effective is unpredictable. Given this uncertain behavioural and immuno-epidemiological context, we developed a modelling framework to explore features that most impact health outcomes and cost effectiveness of long-term administration of LAAB-PrEP against COVID-19 infection in immunocompromised individuals in the English context. The model predicted that the incremental cost-effectiveness ratio (ICER) of LAAB-PrEP against COVID-19 in immunocompromised individuals will be largely driven by features of utility of shielding, current/future shielding behaviour, cost of shielding, risk of COVID-19 hospitalisation among immunocompromised individuals and the time horizon used for the cost-effectiveness analysis. The model estimated that for realistic ranges of influential factors, it is possible for LAAB-PrEP to be cost effective under the conditions that most immunocompromised individuals would shield indefinitely if it were not available but would switch to LAAB-PrEP if it were. Thus, if individuals stop shielding when taking LAAB-PrEP, then LAAB-PrEP is cost effective.