Quality of life and cost‐effectiveness of convalescent plasma compared to standard care for hospitalized COVID‐19 patients in the CONCOR‐1 trial
Preston Tse, Jiajun Yan, Yang Liu, Erin Jamula, Nancy Heddle, Renée Bazin, Nancy Robitaille, Richard Cook, Alexis Turgeon, Dean Fergusson, Marshall Glesby, Kent Cadogan Loftsgard, Melissa Cushing, Michaël Chassé, Nick Daneman, Andrés Finzi, Bruce Sachais, Philippe Bégin, Jeannie Callum, Donald M Arnold, Feng Xie
Transfusion, doi:10.1111/trf.17777
Background: The CONvalescent Plasma for Hospitalized Adults With COVID-19 Respiratory Illness (CONCOR-1) trial was a multicenter randomized controlled trial assessing convalescent plasma in hospitalized COVID-19 patients. This study evaluates the cost-effectiveness of convalescent plasma and its impact on quality-of-life to provide insight into its potential as an alternative treatment in resource-constrained settings. Methods: Individual patient data on health outcomes and resource utilization from the CONCOR-1 trial were used to conduct the analysis from the Canadian public payer's perspective with a time horizon of 30 days post-randomization. Baseline and 30-day EQ-5D-5L were measured to calculate quality-adjusted survival. All costs are presented in 2021 Canadian dollars. The base case assessed the EQ-5D-5L scores of hospitalized inpatients reporting at both timepoints, and a utility score of 0 was assigned for patients who died within 30 days. Costs for all patients enrolled were used. The sensitivity analysis utilizes EQ-5D-5L scores from the same population but only uses costs from this population. Results: 940 patients were randomized: 627 received CCP and 313 received standard care. The total costs were $28,716 (standard deviation, $25,380) and $24,258 ($22,939) for the convalescent plasma and standard care arms respectively. EQ-5D-5L scores were 0.61 in both arms (p = .85) at baseline. At 30 days, Abbreviations: AEs, adverse events; CCP, convalescent plasma; CONCOR-1, convalescent plasma for hospitalized adults with COVID-19 respiratory illness; ECMO,
SUPPORTING INFORMATION Additional supporting information can be found online in the Supporting Information section at the end of this article.
References
Axfors, Janiaud, Schmitt, Van't Hooft, Smith et al., Association between convalescent plasma treatment and mortality in COVID-19: collaborative systematic review and meta-analysis of randomized clinical trials, BMC Infect Dis
Bégin, Callum, Heddle, Cook, Zeller et al., Convalescent plasma for adults with acute COVID-19 respiratory illness (CONCOR-1): study protocol for an international, multicentre, randomized, open-label trial, Trials
Bégin, Callum, Jamula, Cook, Heddle et al., Convalescent plasma for hospitalized patients with COVID-19: an open-label, randomized controlled trial, Nat Med
De Oliveira, De Ávila, De Oliveira, Da, Severino Sampaio et al., Persistent symptoms, quality of life, and risk factors in long COVID: a crosssectional study of hospitalized patients in Brazil, Int J Infect Dis
Don, Michael, Federico, De B-G, Andrew et al., Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations, BMJ
Estcourt, Turgeon, Mcquilten, Mcverry, Al-Beidh et al., Effect of convalescent plasma on organ support-free days in critically ill patients with COVID-19: a randomized clinical trial, JAMA
Feng, Kohlmann, Janssen, Buchholz, Psychometric properties of the EQ-5D-5L: a systematic review of the literature, Qual Life Res
Fenwick, Claxton, Sculpher, Representing uncertainty: the role of cost-effectiveness acceptability curves, Health Econ
Hamilton, Lee, Arnold, Lilford, Hemming, Is convalescent plasma futile in COVID-19? A Bayesian re-analysis of the RECOVERY randomized controlled trial, Int J Infect Dis
Herdman, Gudex, Lloyd, Janssen, Kind et al., Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L), Qual Life Res
Information, COVID-19 hospitalization and emergency department statistics
Joyner, Carter, Senefeld, Klassen, Mills et al., Convalescent plasma antibody levels and the risk of death from Covid-19, N Engl J Med
Korley, Durkalski-Mauldin, Yeatts, Schulman, Davenport et al., Early convalescent plasma for high-risk outpatients with Covid-19, N Engl J Med
Lang-Meli, Fuchs, Mathé, Ho, Kern et al., Case series: convalescent plasma therapy for patients with COVID-19 and primary antibody deficiency, J Clin Immunol
Libster, Marc, Wappner, Coviello, Bianchi et al., Early high-titer plasma therapy to prevent severe Covid-19 in older adults, N Engl J Med
Ortigoza, Yoon, Goldfeld, Troxel, Daily et al., Efficacy and safety of COVID-19 convalescent plasma in hospitalized patients: a randomized clinical trial, JAMA Intern Med
Piechotta, Chai, Valk, Doree, Monsef et al., Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review, Cochrane Database Syst Rev
Senefeld, Klassen, Ford, Senese, Wiggins et al., Use of convalescent plasma in COVID-19 patients with immunosuppression, Transfusion
Tsuzuki, Miyazato, Terada, Morioka, Ohmagari et al., Impact of long-COVID on health-related quality of life in Japanese COVID-19 patients, Health Qual Life Outcomes
Xie, Pullenayegum, Gaebel, Bansback, Bryan et al., A time trade-off-derived value set of the EQ-5D-5L for Canada, Med Care
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'abstract': '<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The '
'CONvalescent Plasma for Hospitalized Adults With COVID‐19 Respiratory Illness (CONCOR‐1) '
'trial was a multicenter randomized controlled trial assessing convalescent plasma in '
'hospitalized COVID‐19 patients. This study evaluates the cost‐effectiveness of convalescent '
'plasma and its impact on quality‐of‐life to provide insight into its potential as an '
'alternative treatment in resource‐constrained '
'settings.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Individual '
'patient data on health outcomes and resource utilization from the CONCOR‐1 trial were used to '
"conduct the analysis from the Canadian public payer's perspective with a time horizon of "
'30\u2009days post‐randomization. Baseline and 30‐day EQ‐5D‐5L were measured to calculate '
'quality‐adjusted survival. All costs are presented in 2021 Canadian dollars. The base case '
'assessed the EQ‐5D‐5L scores of hospitalized inpatients reporting at both timepoints, and a '
'utility score of 0 was assigned for patients who died within 30\u2009days. Costs for all '
'patients enrolled were used. The sensitivity analysis utilizes EQ‐5D‐5L scores from the same '
'population but only uses costs from this '
'population.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>940 patients '
'were randomized: 627 received CCP and 313 received standard care. The total costs were '
'$28,716 (standard deviation, $25,380) and $24,258 ($22,939) for the convalescent plasma and '
'standard care arms respectively. EQ‐5D‐5L scores were 0.61 in both arms '
'(<jats:italic>p</jats:italic>\u2009=\u2009.85) at baseline. At 30\u2009days, EQ‐5D‐5L scores '
'were 0.63 and 0.64 for patients in the convalescent plasma and standard care arms,\xa0'
'respectively (<jats:italic>p</jats:italic>\u2009=\u2009.46). The incremental cost was $4458 '
'and the incremental quality‐adjusted life day was '
'−0.078.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>Convalescent '
'plasma was less effective and more costly than standard care in treating hospitalized '
'COVID‐19.</jats:p></jats:sec>',
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