Features Influencing the Health and Economic Impact of Preventing COVID-19 in Immunocompromised Individuals
Siyu Chen, Sudhir Venkatesan, Sofie Arnetorp, Klas Bergenheim, Sabada Dube, Wilhelmine Meeraus, Cátia Ferreira, Sylvia Taylor, Lisa J. White.
Abstract
Many immunocompromised individuals mount inadequate immune responses following COVID-19 vaccination, thus relying on other social distancing behaviours, particularly shielding, for protection, impacting their quality of life. However, little is known about historical/current levels and effectiveness of shielding or factors influencing individuals’ decision to continue shielding. Long-acting antibody pre-exposure prophylaxis (LAAB-PrEP) provides direct protection against COVID-19 in immunocompromised individuals who have been and may continue to shield.
Introduction
The COVID-19 pandemic instigated an unprecedented global response, including huge efforts to develop pharmaceuticals for prophylaxis against SARS-CoV-2. The COVID-19 vaccines, delivered as regular booster doses, are highly effective at reducing disease severity and mortality.
However, some individuals, such as those who are immunocompromised, may mount an inadequate immune response to COVID-19 vaccines, leaving them at risk of COVID-19. Immunocompromised individuals comprise 2–7% of the global population and, regardless of their vaccination status, during the pandemic they remained at substantially greater risk of severe or fatal COVID-19 than their non-immunocompromised counterparts.
Materials and Methods:
We created a model for a hypothetical cohort with a population size of 1,000, denoted as , who are assumed to be the target population for the hypothetical LAAB-PrEP, i.e., individuals who are immunocompromised. However, immunocompromised individuals comprise a heterogeneous population with varying degrees of primary conditions that can not only contribute to disutility in the absence of COVID-19 but also lead to great uncertainties around the risk of infection and severity of COVID-19.
Discussion:
Here, we present a modelling framework to evaluate which features of a hypothetical pharmaceutical intervention (LAAB-PrEP), in combination with shielding, have the greatest influence on the health and economic impacts of that intervention in England or a similar setting. The target population for this intervention is individuals who are immunocompromised and thus at high risk of severe COVID-19 and its complications. The current standard of care for COVID-19 prophylaxis in this risk group is shielding, a non-pharmaceutical intervention. As noted earlier, creating a single framework to evaluate and compare pharmaceutical and non-pharmaceutical interventions is challenging.
Citation: Chen S, Venkatesan S, Arnetorp S, Bergenheim K, Dube S, Meeraus W, et al. (2025) Features influencing the health and economic impact of preventing COVID-19 in immunocompromised individuals. PLoS Comput Biol 21(6): e1013072. https://doi.org/10.1371/journal.pcbi.1013072
Editor: Joseph T. Wu, University of Hong Kong, HONG KONG
Received: May 3, 2024; Accepted: April 21, 2025; Published: June 2, 2025.
Copyright: © 2025 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All data, code and materials used in the analyses can be accessed at: https://github.com/SiyuChenOxf/Modelling-for-CEA-shielding-and-LAAB. All parameter estimates and figures presented can be reproduced using the code provided.
Funding: This work was conducted at the University of Oxford with partial funding from the AstraZeneca-sponsored RAVEN study (EUPAS43571; NCT05047822 to LJW and SC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: SV, WM, KB, SA, SD and CF are employees of AstraZeneca and hold AstraZeneca stocks/shares. ST is a former employee of AstraZeneca. LJW is the director of Model Health Ltd, a company that provides paid consultancy services to AstraZeneca.
