Inpatient COVID-19 Mortality Has Reduced Over Time: Results from an Observational Cohort

Bechman, Katie; Yates, Mark; Mann, Kirsty; Nagra, Deepak; Smith, Laura-Jane; Rutherford, Andrew I; Periselneris, Jimstan; Walder, David; Dobson, Richard; Kraljević, Željko; Teo, James; Bernal, William; Barker, Richard D.; Galloway, James; Norton, Sam

doi:10.2139/ssrn.3786058

Cited by 3 publications

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“…Of these, three studies used 2020 US Dollars [ 28 , 30 , 37 ], one study used Euros (cost year not reported) [ 34 ], and one study used 2020 Chinese Yuan (CN¥) [ 35 ] in cost calculations. Most studies either used a healthcare system perspective ( n = 4) [ 28 , 32 , 34 , 35 ], or an individual hospital perspective ( n = 3) [ 27 , 31 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…In three studies assessing the frequency of remdesivir prescription between March and November 2020 (towards the beginning of the pandemic), a general increase was seen ( Fig. 5 ) [ 29 , 31 , 33 ]. Bechman 2021, a UK-based observational study including 3,595 patients, reported that remdesivir was prescribed to 0.1% of hospitalised patients during the first wave of the pandemic, 14.5% during the period between the first and second wave and 33.4% in the second wave [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…5 ) [ 29 , 31 , 33 ]. Bechman 2021, a UK-based observational study including 3,595 patients, reported that remdesivir was prescribed to 0.1% of hospitalised patients during the first wave of the pandemic, 14.5% during the period between the first and second wave and 33.4% in the second wave [ 33 ]. Meanwhile, a Spanish hospital cohort study of 1,645 patients, Garcia-Vidal 2021, reported that remdesivir use increased from 3% in April 2020 to 62% in July 2020 in hospitalised patients, but decreased in August and September 2020, to 53% and 36.5% [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…In both studies, similar trends were observed for the prescription of dexamethasone, suggesting that remdesivir and dexamethasone were used together. Indeed, Bechman 2021 also reported that 98.8% of patients receiving remdesivir were co-prescribed dexamethasone [ 33 ]. Mozaffari 2021, a US-based real-world utilisation study also found that the percentage of remdesivir use increased, from 5% in May 2020 to 47% in November 2020 [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

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Remdesivir-related cost-effectiveness and cost and resource use evidence in COVID-19: a systematic review

et al. 2022

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Background The coronavirus disease 2019 (COVID-19) pandemic has been a global health emergency since December 2019, leading to millions of deaths worldwide and placing significant pressures, including economic burden, on individual patients and healthcare systems. As of February 2022, remdesivir is the only US Food and Drug Administration (FDA)-approved treatment for severe COVID-19. This systematic literature review (SLR) aimed to summarise economic evaluations, and cost and resource use (CRU) evidence related to remdesivir during the COVID-19 pandemic. Methods Searches of MEDLINE, Embase the International Health Technology Assessment (HTA) database, reference lists, congresses and grey literature were performed in May 2021. Articles were reviewed for relevance against pre-specified criteria by two independent reviewers and study quality was assessed using published checklists. Results Eight studies reported resource use and five reported costs related to remdesivir. Over time, the prescription rate of remdesivir increased and time from disease onset to remdesivir initiation decreased. Remdesivir was associated with a 6% to 21.3% decrease in bed occupancy. Cost estimates for remdesivir ranged widely, from $10 to $780 for a 10-day course. In three out of four included economic evaluations, remdesivir treatment scenarios were cost-effective, ranging from ~ 8 to ~ 23% of the willingness-to-pay threshold for the respective country. Conclusions Economic evidence relating to remdesivir should be interpreted with consideration of the broader clinical context, including patients’ characteristics and the timing of its administration. Nonetheless, remdesivir remains an important option for physicians in aiming to provide optimal care and relieve pressure on healthcare systems through shifting phases of the pandemic.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Remdesivir-related cost-effectiveness and cost and resource use evidence in COVID-19: a systematic review

et al. 2022

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“…Another important consideration in PS model specification is to account for the temporal variations in treatment allocation, case mix and case fatality, each of which can lead to bias [ 19 , 20 ]. For example, according to England’s Hospital Episode Statistics administrative dataset, proportions of older, frail, female and white patients admitted to hospital increased steadily between March and May 2020 as the outbreak moved out of larger cities with younger populations [ 18 ].…”

Section: Considerations In the Presence Of Temporal Variations In The Management Of Covid-19mentioning

confidence: 99%

Comparative effectiveness research in COVID-19 using real-world data: methodological considerations

Read¹,

Khachatryan²,

Chandak

et al. 2021

J. Comp. Eff. Res.

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Comparison of COVID-19 survival in relation to CPAP length of treatment and by comorbidity and transmission setting (community or hospital acquired) in a medium-sized UK hospital in 2020: a retrospective study

et al. 2022

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ObjectiveTo estimate continuous positive airway pressure (CPAP) length of treatment effect on survival of hospitalised COVID-19 patients in a medium-sized UK Hospital, and how this effect changes according to the patient’s comorbidity and COVID-19 route of acquisition (community or nosocomial) during the two waves in 2020.SettingThe acute inpatient unit in Wrightington, Wigan and Leigh Teaching Hospitals National Health Service (NHS) Foundation Trust (WWL), a medium-sized NHS Trust in north-west of England.DesignRetrospective cohort of all confirmed COVID-19 patients admitted in WWL during 2020.Participants1830 patients (568 first wave, 1262 s wave) with antigen confirmed COVID-19 disease and severe acute respiratory syndrome admitted between 17 March 2020 (first confirmed COVID-19 case) and 31 December 2020.Outcome measureCOVID-19 survival rate in all patients and survival rate in potentially hospital-acquired COVID-19 (PHA) patients were modelled using a predictor set which include comorbidities (eg, obesity, diabetes, chronic ischaemic heart disease (IHD), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD)), wave, age, sex and care home residency, and interventions (remdesivir, dexamethasone, CPAP, intensive care unit (ICU), intubation). Secondary outcome measure was CPAP length, which was modelled using the same predictors of the survival rate.ResultsMortality rate in the second wave was significantly lower than in the first wave (43.4% vs 28.1%, p<0.001), although for PHA COVID-19 patients mortality did not reduce, remaining at very high levels independently of wave and CPAP length. For all cohort, statistical modelling identified CPAP length (HR 95% CI 0.86 to 0.96) and women (HR 95% CI 0.71 to 0.81) were associated with improved survival, while being older age (HR 95% CI 1.02 to 1.03) admitted from care homes (HR 95% CI 2.22 to 2.39), IHD (HR 95% CI 1.13 to 1.24), CKD (HR 95% CI 1.14 to 1.25), obesity (HR 95% CI 1.18 to 1.28) and COPD-emphysema (HR 95% CI 1.18 to 1.57) were associated with reduced survival. Despite the detrimental effect of comorbidities, patients with CKD (95% CI 16% to 30% improvement in survival), IHD (95% CI 1% to 10% improvement in survival) and asthma (95% CI 8% to 30% improvement in survival) benefitted most from CPAP length, while no significant survival difference was found for obese and patients with diabetes.ConclusionsThe experience of an Acute Trust during the COVID-19 outbreak of 2020 is documented and indicates the importance of care home and hospitals in disease acquisition. Death rates fell between the first and second wave only for community-acquired COVID-19 patients. The fall was associated to CPAP length, especially for some comorbidities. While uncovering some risk and protective factors of mortality in COVID-19 studies, the study also unravels how little is known about PHA COVID-19 and the interaction between CPAP and some comorbidities.

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Inpatient COVID-19 Mortality Has Reduced Over Time: Results from an Observational Cohort

Cited by 3 publications

References 0 publications

Remdesivir-related cost-effectiveness and cost and resource use evidence in COVID-19: a systematic review

Remdesivir-related cost-effectiveness and cost and resource use evidence in COVID-19: a systematic review

Comparative effectiveness research in COVID-19 using real-world data: methodological considerations

Comparison of COVID-19 survival in relation to CPAP length of treatment and by comorbidity and transmission setting (community or hospital acquired) in a medium-sized UK hospital in 2020: a retrospective study

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