COVID-19 Scan for Feb 15, 2022

News brief

Many COVID-19 patients left with bills after cost-sharing waivers expired

A large proportion of US COVID-19 patients were left with thousands of dollars of hospital bills after many health insurers stopped issuing cost-sharing waivers in early 2021, finds a study published yesterday in JAMA Network Open.

A team led by University of Michigan at Ann Arbor researchers mined the IQVIA PharMetrics Plus for Academics database for COVID-19 hospital claims for patients covered by Medicare Advantage or private insurance from Mar 1, 2020, to Mar 30, 2021.

During the study period, 15,625 COVID-19 patients were hospitalized 16,450 times. Average patient age was 67.7 years, and 51.9% were male.

Among privately insured patients, 2.2% to 8.8% of COVID-19 hospitalizations involved cost sharing for facility services from March 2020 to January 2021, then rose to 82.1% to 84.4% in February and March 2021. This proportion increased from 0.3% to 2.7% among Medicare Advantage patients from March 2020 to February 2021, then climbed to 66.1% in March 2021.

Privately insured patients had 4,926 hospitalizations, 753 (15.3%) of which involved cost sharing for facility services. Average total out-of-pocket cost was $3,998, which was positively associated with length of stay and residence in a non-Northeastern state.

Medicare Advantage patients were hospitalized 11,524 times, with 406 (3.5%) involving cost sharing for facility services. Average total out-of-pocket cost was $1,638, which was negatively associated with enrollment in a preferred provider organization and residence in a Western state, while length of stay was positively associated.

The study authors noted that, during 2020, most private and Medicare Advantage insurers waived cost sharing for COVID-19 hospitalizations but stopped the practice by August 2021, a move they said was premature in light of the ongoing pandemic.

"Findings suggest that patients could face substantial bills for COVID-19 hospitalization going forward," the researchers wrote. "While the potential size of these bills may convince a few patients to become vaccinated, it could also prompt patients to delay seeking care irrespective of vaccination status, as both the vaccinated and unvaccinated are both now subject to cost sharing."
Feb 14 JAMA Netw Open research letter

Higher estrogen in older women may lower the risk of COVID-19 death

Older women's estrogen levels may be linked to their chances of dying from COVID-19, with higher levels of the hormone seemingly protective against severe infection, according to an observational study yesterday in BMJ Open.

The study included 14,685 postmenopausal Swedish women from 50 to 80 years old who had COVID-19. Researchers divided them into three groups: (1) women with previously diagnosed breast cancer and receiving endocrine therapy (decreased estrogen levels), (2) women receiving hormone replacement therapy (increased estrogen), and (3) a control group of women not receiving either therapy.

There were 227 women in group 1 (2%), 2,535 in group 2 (17%), and 11,923 controls (81%). All were diagnosed as having COVID-19 sometime from Feb 1 to Sep 14, 2020.

The investigators found that the unadjusted odd ratios (ORs) for death following COVID-19 were 2.35 (95% confidence interval [CI], 1.51 to 3.65) for group 1 and 0.45 (95% CI, 0.34 to 0.6) for group 2, but only the adjusted OR for death remained statistically significant for group 2, with an OR of 0.47, or a slightly more than 50% reduction. Absolute risk of death was 4.6% for the control group versus 10.1% and 2.1% for the decreased and increased estrogen groups, respectively.

As reflected in numerous previous studies, age was significantly associated with the risk of dying from COVID-19, with each extra year tied to a 15% greater risk, while each coexisting medical condition increased the odds of death by 13%.

The researchers conclude, "This study shows an association between oestrogen levels and COVID-19 death. Consequently, drugs increasing oestrogen levels may have a role in therapeutic efforts to alleviate COVID-19 severity in postmenopausal women and could be studied in randomised control trials."
Feb 14 BMJ Open study

News Scan for Feb 15, 2022

News brief

Pharmacist-developed app aims to improve antimicrobial prescribing

The Commonwealth Pharmacists Association (CPA) last week announced a new program to improve surveillance and prescribing of antimicrobials in low- and middle-income countries (LMICs) .

The Surveillance and Prescribing support for Antimicrobial Stewardship Resource Capacity Building (SPARC) program will re-develop and expand the availability of an antimicrobial prescribing smartphone app, adding updated core prescribing guidance and information on additional good stewardship practices. Veterinary antimicrobial prescribing and stewardship guidance will also be added to the app, which was developed and launched a few years ago by CPA.

"We aim to provide increased support for antimicrobial use surveillance in human health and empower frontline clinicians with improved access to their national standard treatment guidelines as well as internationally recognized antimicrobial stewardship guidelines through the development and rollout of an antimicrobial prescribing and stewardship smartphone app for human and animal health," CPA Technical Program Lead Diane Ashiru-Oredope, PhD, said in a press release.

The program will be funded through the UK Department of Health and Social Care's Fleming Fund. The app will be available in 22 LMICs in Africa and Asia where the Fleming Fund is active.

SPARC also aims to develop workshops and provide practical assistance for up to six countries to carry out a global point-prevalence survey to track antimicrobial use.
Feb 9 CPA press release

H5N6 avian flu infects 2 more people in China

China reported two more human H5N6 avian flu infections, both involving people who had been exposed to poultry before they got sick, Hong Kong's Centre for Health Protection (CHP) said today in a statement. The illnesses bring the total this year to five.

One of the patients is a 50-year-old man from the city of Baise in Guangxi province, located in southern China near the border with Vietnam. His symptoms began on Jan 12 after he had been exposed to live poultry. He was hospitalized the next day and is listed in critical condition.

The second illness involves a 35-year-old man from Zhenjiang City in Jiangsu province on China's east-central coast. The investigation found that he had visited a live poultry market before his symptoms started on Jan 15. He was admitted to the hospital on Jan 19 and is in critical condition.

China has been reporting sporadic human H5N6 cases since 2014, but last year, it reported a steep rise in infections. Since the first report, the country has reported 67 cases, roughly half of them reported in 2021. The virus is known to circulate in a few Asian nations, including China. However, China and Laos are the only countries that have reported human cases.
Feb 15 CHP statement

Nigeria reports higher-than-normal spike in Lassa fever activity

Though Lassa fever is endemic in Nigeria, the country is experiencing a spike in cases that is higher than the normal rise seen during the dry season, which spans December through April, the World Health Organization (WHO) said yesterday.

Between Jan 3 and Jan 30, there were 211 lab-confirmed cases and 40 deaths. Illnesses were reported from 14 of Nigeria's 35 states, but 3 reported 82% of cases: Ondo, Edo, and Bauchi. Five of the infections involved healthcare workers.

The WHO noted that over the same time period in 2021, there were few cases and less geographic spread. It warned that the number of cases will likely rise further until the dry season ends and that the national risk to Nigeria is high.

Nigeria's spike in Lassa fever cases is likely due to a combination of factors, the WHO said. They include gaps in surveillance and response capacity, delays in lab shipments, conversion of Lassa treatment capacity for COVID-19 purposes, and suboptimal infection prevention and control practices.

Lassa fever virus spreads through food and environments contaminated with urine and feces of Mastomys rats that carry the virus. The virus can cause a hemorrhagic disease in humans, and person-to-person spread can occur through contact with an infected patient's body fluids.
Feb 14 WHO statement