Real-world data to evaluate effects of a multi-level dissemination strategy on access, outcomes, and equity of monoclonal antibodies for COVID-19

Mika K Hamer; Chelsea Sobczak; Lindsey Whittington; Rachel L Bowyer; Ramona Koren; Joel A Begay; Hillary D Lum; Adit A Ginde; Matthew K Wynia; Bethany M Kwan

doi:10.1017/cts.2023.679

Real-world data to evaluate effects of a multi-level dissemination strategy on access, outcomes, and equity of monoclonal antibodies for COVID-19

J Clin Transl Sci. 2023 Nov 13;7(1):e258. doi: 10.1017/cts.2023.679. eCollection 2023.

Authors

Mika K Hamer¹, Chelsea Sobczak², Lindsey Whittington³, Rachel L Bowyer³, Ramona Koren⁴, Joel A Begay⁵, Hillary D Lum⁶, Adit A Ginde^{7

8}, Matthew K Wynia^{1

8

9}, Bethany M Kwan^{2

7

8}

Affiliations

¹ Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
² Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
³ Colorado Health Institute, Denver, CO, USA.
⁴ Patient Partner/Community Affiliate, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁵ Johns Hopkins Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
⁷ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
⁸ Colorado Clinical & Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁹ Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.

Abstract

Introduction: Multi-level dissemination strategies are needed to increase equitable access to effective treatment for high-risk outpatients with COVID-19, particularly among patients from disproportionately affected communities. Yet assessing population-level impact of such strategies can be challenging.

Methods: In collaboration with key contributors in Colorado, we conducted a retrospective cohort study to evaluate a multi-level dissemination strategy for neutralizing monoclonal antibody (mAb) treatment. Real-world data included county-level, de-identified output from a statewide mAb referral registry linked with publicly available epidemiological data. Outcomes included weekly number of mAb referrals, unique referring clinicians, and COVID-19 hospitalization rates. We assessed weekly changes in outcomes after dissemination strategies launched in July 2021.

Results: Overall, mAb referrals increased from a weekly average of 3.0 to 15.5, with an increase of 1.3 to 42.1 additional referrals per county in each post-period week (p < .05). Number of referring clinicians increased from a weekly average of 2.2 to 9.7, with an additional 1.5 to 22.2 unique referring clinicians observed per county per week beginning 5 weeks post-launch (p < .001). Larger effects were observed in communities specifically prioritized by the dissemination strategies. There were no observed differences in COVID-19 hospitalization rates between counties with and without mAb treatment sites.

Conclusion: Real-world data can be used to estimate population impact of multi-level dissemination strategies. The launch of these strategies corresponded with increases in mAb referrals, but no apparent population-level effects on hospitalization outcomes. Strengths of this analytic approach include pragmatism and efficiency, whereas limitations include inability to control for other contemporaneous trends.

Keywords: COVID-19; dissemination and implementation; monoclonal antibodies; real-world effectiveness; stakeholder engagement.