Journal Article Research Support, Non-U.S. Gov't Ppublish
PubMed: 39449663 DOI: 10.1093/cid/ciae517
Public Health Benefits of Applying Evidence-Based Best Practices in Managing Patients Hospitalized for COVID-19.
Clin Infect Dis 79(Suppl 4):S160-S166
Authors: Andre C Kalil, Aastha Chandak, Luke S P Moore, Neera Ahuja, Martin Kolditz, Roman Casciano, Ananth Kadambi, Mohsen Yaghoubi, Sotirios Tsiodras, Jakob J Malin, Essy Mozaffari, Michele Bartoletti
Affiliations
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA.
- Evidence and Access, Certara, New York, New York, USA.
- Department of Infectious Diseases, Imperial College, London, United Kingdom.
- Department of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA.
- Medical Department I, Division of Pulmonology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
- Professor of Medicine and Infectious Diseases, National & Kapodistrian University of Athens Medical School, Chair, 4th Department of Internal Medicine, Attikon University Hospital, Athens, Greece.
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Medical Affairs, Gilead Sciences, Foster City, California, USA.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
Abstract
BACKGROUND
As coronavirus disease 2019 (COVID-19)-related mortality remains a concern, optimal management of patients hospitalized for COVID-19 continues to evolve. We developed a population model based on real-world evidence to quantify the clinical impact of increased utilization of remdesivir, the effectiveness of which has been well established in hospitalized patients with COVID-19.
METHODS
The PINC AI healthcare database records for patients hospitalized for COVID-19 from January to December 2023 were stratified by those treated with or without remdesivir ("RDV" and "no RDV") and by supplemental oxygen requirements: no supplemental oxygen charges (NSOc), low-flow oxygen (LFO), and high-flow oxygen/non-invasive ventilation. Key vulnerable subgroups such as elderly and immunocompromised patients were also evaluated. The model applied previously published hazard ratios (HRs) to 28-day in-hospital mortality incidence to determine the number of potential lives saved if additional no RDV patients had been treated with remdesivir upon hospital admission.
RESULTS
Of 84 810 hospitalizations for COVID-19 in 2023, 13,233 no RDV patients were similar in terms of characteristics and clinical presentation to the RDV patients. The model predicted that initiation of remdesivir in these patients could have saved 231 lives. Projected nationally, this translates to >800 potential lives saved (95% confidence interval, 469-1126). Eighty-nine percent of potential lives saved were elderly and 19% were immunocompromised individuals. Seventy-six percent were among NSOc or LFO patients.
CONCLUSIONS
This public health model underscores the value of initiating remdesivir upon admission in patients hospitalized for COVID-19, in accordance with evidence-based best practices, to minimize lives lost because of severe acute respiratory syndrome coronavirus 2 infection.
MeSH
Mortality, Data Science, Hospital Mortality, Public Health, Aged, Covid-19, Communicable Diseases