A Novel Approach to Equitable Distribution of Scarce Therapeutics
| Autor: | Parag A. Pathak, M. Utku Ünver, Sarah P. Hammond, Alyssa R. Letourneau, Tayfun Sönmez, Scott Dryden-Peterson, Inga T. Lennes, Emily Rubin |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Retrospective review 2019-20 coronavirus outbreak Emergency Use Authorization Coronavirus disease 2019 (COVID-19) business.industry media_common.quotation_subject Distribution (economics) Critical Care and Intensive Care Medicine medicine.disease Scarcity Food and drug administration Lottery medicine Medical emergency Cardiology and Cardiovascular Medicine business media_common |
| Zdroj: | Chest. 160:2324-2331 |
| ISSN: | 0012-3692 |
| Popis: | Background In fall 2020, the Food and Drug Administration issued emergency use authorization for monoclonal antibody (mAb) therapies for outpatients with COVID-19. The Commonwealth of Massachusetts issued guidance outlining the use of a reserve system with a lottery for allocation of mAbs in the event of scarcity that would prioritize socially vulnerable patients for 20% of the infusion slots. The Mass General Brigham health system subsequently implemented such a reserve system. Research Question Can a reserve system be deployed successfully in a large health system in a way that promotes equitable access to mAb therapy among socially vulnerable patients with COVID-19? Study Design and Methods We conducted a retrospective review of the operation of the reserve system for allocation of mAb therapies to identify how referrals moved through the allocation process and what proportion of patients who were offered and received mAb therapies were socially vulnerable. Results Notwithstanding multiple operational challenges, the reserve system for allocation of mAb therapy worked as intended to enhance the number of socially vulnerable patients who were offered and received mAb therapy. A significantly higher proportion of patients offered mAb therapy were socially vulnerable (27.0%) than would have been the case if the infusion appointments had been allocated using a pure lottery system without a vulnerable reserve (19.8%), and a significantly higher proportion of patient who received infusions were socially vulnerable (25.3%) than would have been the case if the infusion appointments had been allocated using a pure lottery system (17.6%) Interpretation Our health system experience demonstrates that a reserve system with a lottery for tiebreaking is a viable way to distribute scarce therapeutics when enhancing access for certain groups is desirable. |
| Databáze: | OpenAIRE |
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