Weighted ‘lottery’ increased access to remdesivir early in COVID-19 pandemic
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A weighted lottery that was designed to increase access to remdesivir early in the COVID-19 pandemic for those most affected by the virus resulted in more equitable distribution of the medication, researchers reported.
“We had two aims in this project. First, to develop a centralized lottery to allocate scarce COVID-19 therapeutics in a way that both promoted equity and also promoted population health outcomes,” Douglas B. White, MD, MAS, vice chair and professor of critical care medicine in the department of critical care medicine at the University of Pittsburgh School of Medicine, said during a presentation at the American Thoracic Society International Conference. “And, second, to determine the feasibility of deploying this centralized lottery to allocate scarce remdesivir when there was scarcity in spring 2020, across 21 hospitals and then to examine whether it actually promoted efficient and equitable allocation.”
White and colleagues convened a multi-institution consortium of experts to develop a weighted lottery in which some patients would be given higher or lower priority for receiving remdesivir (Veklury, Gilead Sciences). More weight was assigned to patients from disadvantaged communities and essential workers, and less weight to patients with at high risk for mortality due to a terminal condition and those with severe respiratory failure. The consortium members were experts in bioethics, economics, health disparities, medicine, pharmacy and health law, according to a press release.
The lottery was implemented across 21 hospitals within the University of Pittsburgh Medical Center (UPMC) health system from May to July 2020 during periods of inadequate remdesivir access. Using administrative data and phone-based screening, researchers identified patients who were eligible for remdesivir. They then calculated the number of potentially eligible patients each week, based on the number of patients who were eligible in the previous week. Using the weighting system, a drug-allocation team met each day to determine each eligible patient’s change of receiving the drug, and used a random number generator to run the lottery, according to the release.
There were 93 patients eligible for remdesivir in the lottery. Among the eligible patients, 44% were from disadvantaged neighborhoods, 20% were essential workers and 9% had an underlying end-stage medical condition.
“During that period of scarcity in spring 2020, there were only 55 courses of remdesivir. Available for 93 [eligible] patients, we allocated all 55 doses,” White said during the presentation.
Overall, 61% of the available 55 doses of remdesivir was allocated to patients from disadvantaged neighborhoods and/or were essential workers, who made up 56% of the COVID-19 patient population, according to the release.
“Our feasibility metrics showed that it was feasible to carry out the proactive screening process to conduct a centralized lottery and then to get the drug to those who are allocated in the lottery. We also found that the weightings in the lottery resulted in the intended effects in general, with essential workers and individuals from disadvantaged communities being more likely to be allocated treatment in the lottery,” White said.