Résumé
Objectives: The United Kingdom (UK) implemented an autumn 2022 booster programme that allowed those at higher risk from COVID-19, including those >= 50 years, to receive a booster to increase protection against infection and subsequent severe outcomes. As the UK transitions out of the pandemic, future booster campaigns may be required to maintain protection against such outcomes. The objective of this analysis was to estimate the value-based price (VBP) for a bivalent COVID-19 vaccine used in a future autumn 2023 campaign in the UK to protect people aged >= 50 years. Method(s): A Susceptible-Exposed-Infected-Recovered (SEIR) model was used to predict infections across a 1-year time horizon starting September 2023 with and without an autumn booster campaign. Initial effectiveness was predicted to be 89% and 97% against infection and hospitalization respectively based on BA.4/BA.5 antibody titers and correlates of protection. A monthly decline in protection of 1.4% and 4.8%, respectively, was assumed based on monovalent vaccine data. A decision tree was used to predict the quality-adjusted life-years (QALY) lost and costs associated with infections. Result(s): Considering a willingness-to-pay (WTP) threshold of 20,000/QALY, the VBP associated with an autumn 2023 booster campaign is 343/dose. Considering a WTP threshold of 30,000, the VBP increases to 476. In sensitivity analyses, excluding the post-infection costs (e.g., long COVID), reduces the VBP by 11%. Varying the hospitalization rates by +/-25% changes the VBP by +/- 6%. Varying hospitalization unit costs only impacts the VBP by 1%. Doubling the rate of waning for booster effectiveness increases the VBP by 54% because the effectiveness provided from past campaigns falls faster and an autumn 2023 booster becomes more valuable. Conclusion(s): While the trajectory of COVID-19 incidence is highly uncertain, pricing the bivalent booster lower than the VBP is expected to result in a cost-effective strategy for the UK.Copyright © 2023
Résumé
Background: Patients with cystic fibrosis (CF) are at high risk of developing severe forms of viral respiratory infections. This study aimed at comparing symptoms and clinical course of SARS-CoV2 infection with other respiratory infections in patients with CF. Methods: We carried out a prospective multicentre cohort study within the Italian CF Society involving 32 CF centres following 6,597 patients. CF centres were contacted to collect baseline and follow-up data of all patients who had reported symptoms suggestive of COVID-19 or who had had contact with a positive/suspected case between the end of February and July 2020. Symptoms and clinical course of the infection were compared between patients who tested positive by molecular testing (cases) and those who tested negative (controls). Results: Thirty patients were reported from the centres, 16 of whom tested positive and 14 negative. Fever, cough, asthenia and dyspnea were the most frequently reported symptoms and their frequency were not significant different between groups. Eight cases (50%) were hospitalised but none required ICU admission. Two adults with a history of lung transplant required non-invasive ventilation;none required ICU admission. All patients fully recovered without short-term sequelae. Changes in FEV1 (percent of predicted) after recovery were not significantly different between groups (median, interquartile range: 3.0%, –1.5, 5.5 among cases and –3.0%, –8.5, 6.3 among controls, P = 0.48). Conclusions: Symptoms and clinical course of SARS-CoV-2 infection in our patients was not significantly different from other respiratory infections. The clinical course of COVID-19 was relatively favourable, however CF patients with severely impaired respiratory function and organ transplant may develop complications and a negative outcome. The study is ongoing, and we are recruiting patients during the second wave of the pandemic.