{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:56:18Z","timestamp":1777658178941,"version":"3.51.4"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Pre-exposure prophylaxis with neutralizing SARS-CoV-2 monoclonal antibodies (mAbs PrEP) prevents infection and reduces hospitalizations and the duration thereof for COVID-19 and death among high-risk individuals. However, reduced effectiveness due to a changing SARS-CoV-2 viral landscape and high drug prices remain substantial implementation barriers.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the cost-effectiveness of mAbs PrEP as COVID-19 PrEP.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>For this economic evaluation, a decision analytic model was developed and parameterized with health care outcome and utilization data from individuals with high risk for COVID-19. The SARS-CoV-2 infection probability, mAbs PrEP effectiveness, and drug pricing were varied. All costs were collected from a third-party payer perspective. Data were analyzed from September 2021 to December 2022.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Health care outcomes including new SARS-CoV-2 infections, hospitalization, and deaths. The cost per death averted and cost-effectiveness ratios using a threshold for prevention interventions of $22\u202f000 or less per quality-adjusted life year (QALY) gained.<\/jats:p><\/jats:sec>Results<\/jats:title>The clinical cohort consisted of 636 individuals with COVID-19 (mean [SD] age 63 [18] years; 341 [54%] male). Most individuals were at high risk for severe COVID-19, including 137 (21%) with a body mass index of 30 or higher, 60 (9.4%) with hematological malignant neoplasm, 108 (17%) post-transplantation, and 152 (23.9%) who used immunosuppressive medication before COVID-19. Within the context of a high (18%) SARS-CoV-2 infection probability and low (25%) effectiveness the model calculated a short-term reduction of 42% ward admissions, 31% intensive care unit (ICU) admissions, and 34% deaths. Cost-saving scenarios were obtained with drug prices of $275 and 75% or higher effectiveness. With a 100% effectiveness mAbs PrEP can reduce ward admissions by 70%, ICU admissions by 97%, and deaths by 92%. Drug prices, however, need to reduce to $550 for cost-effectiveness ratios less than $22\u202f000 per QALY gained per death averted and to $2200 for ratios between $22\u202f000 and $88\u202f000.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this study, use of mAbs PrEP for preventing SARS-CoV-2 infections was cost-saving at the beginning of an epidemic wave (high infection probability) with 75% or higher effectiveness and drug price of $275. These results are timely and relevant for decision-makers involved in mAbs PrEP implementation. When newer mAbs PrEP combinations become available, guidance on implementation should be formulated ensuring a fast rollout. Nevertheless, advocacy for mAbs PrEP use and critical discussion on drug prices are necessary to ensuring cost-effectiveness for different epidemic settings.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.21985","type":"journal-article","created":{"date-parts":[[2023,7,6]],"date-time":"2023-07-06T15:32:28Z","timestamp":1688657548000},"page":"e2321985","source":"Crossref","is-referenced-by-count":15,"title":["Health Outcomes and Cost-effectiveness of Monoclonal SARS-CoV-2 Antibodies as Pre-exposure Prophylaxis"],"prefix":"10.1001","volume":"6","author":[{"given":"Stephanie","family":"Popping","sequence":"first","affiliation":[{"name":"Centre for Experimental and Molecular Medicine, Amsterdam University Medical Centres\u2014Location AMC, Amsterdam, the Netherlands"},{"name":"Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brooke E.","family":"Nichols","sequence":"additional","affiliation":[{"name":"Foundation for Innovative New Diagnostics, Geneva, Switzerland"},{"name":"Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brent","family":"Appelman","sequence":"additional","affiliation":[{"name":"Centre for Experimental and Molecular Medicine, Amsterdam University Medical Centres\u2014Location AMC, Amsterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason J.","family":"Biemond","sequence":"additional","affiliation":[{"name":"Centre for Experimental and Molecular Medicine, Amsterdam University Medical Centres\u2014Location AMC, Amsterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magda","family":"Vergouwe","sequence":"additional","affiliation":[{"name":"Centre for Experimental and Molecular Medicine, Amsterdam University Medical Centres\u2014Location AMC, Amsterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frits R.","family":"Rosendaal","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"van der Valk","sequence":"additional","affiliation":[{"name":"Stichting HIV Monitoring, Amsterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Godelieve J.","family":"de Bree","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. 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