key: cord-0074550-2kmejo7w authors: Kipnis, Patricia; Soltesz, Lauren; Escobar, Gabriel J.; Myers, Laura; Liu, Vincent X. title: Evaluation of Vaccination Strategies to Compare Efficient and Equitable Vaccine Allocation by Race and Ethnicity Across Time date: 2021-08-20 journal: JAMA Health Forum DOI: 10.1001/jamahealthforum.2021.2095 sha: 4572010d9648aeb72595f8ae927e653a0b5c51b5 doc_id: 74550 cord_uid: 2kmejo7w IMPORTANCE: Identifying the most efficient COVID-19 vaccine allocation strategy may substantially reduce hospitalizations and save lives while ensuring an equitable vaccine distribution. OBJECTIVE: To simulate the association of different vaccine allocation strategies with COVID-19–associated morbidity and mortality and their distribution across racial and ethnic groups. DESIGN, SETTING, AND PARTICIPANTS: We developed and internally validated the risk of COVID-19 infection and risk of hospitalization models on randomly split training and validation data sets. These were used in a computer simulation study of vaccine prioritization among adult health plan members who were drawn from an integrated health care delivery system. The study was conducted from January 3, 2021, to June 1, 2021, in Oakland, California, and the data were analyzed during the same period. MAIN OUTCOMES AND MEASURES: We simulated the association of different vaccine allocation strategies, including (1) random, (2) a US Centers for Disease Control and Prevention (CDC) proxy, (3) age based, and (4) combinations of models for the risk of adverse outcomes (CRS) and COVID-19 infection (PROVID), with COVID-19-related hospitalizations between May 1, 2020, and December 31, 2020, that were randomly permuted by month across 250 simulations and assessed vaccine allocation by race and ethnicity and the neighborhood deprivation index across time. RESULTS: The study included 3 202 679 adult patients (mean [SD] age, 48.2 [18.0] years; 1 677 637 women [52.4%]; 1 525 042 men [47.6%]; 611 154 Asian [19.1%], 206 363 Black [6.4%], 642 344 Hispanic [20.1%], and 1 390 638 White individuals [43.4%]), of whom 36 137 (1.1%) were positive for SARS-CoV-2. A risk-based strategy (CRS/PROVID) showed the largest avoidable hospitalization estimates (4954; 95% CI, 3452-5878) followed by age-based (4362; 95% CI, 2866-5175) and CDC proxy (4085; 95% CI, 2805-5109) strategies. Random vaccination showed substantially lower reductions in adverse outcomes. Risk-based strategies also showed the largest number of avoidable COVID-19 deaths (joint CRS/PROVID) and household transmissions. Risk-based (PROVID) and CDC proxy strategies were estimated to vaccinate the highest percentage of Hispanic and Black patients in 8 months (joint CRS/PROVID: 642 570 [100%] Hispanic, 185 530 [90%] Black; PROVID: 642 570 [100%] Hispanic, 198 480 [96%] Black; CDC proxy: 605 770 [95%] Hispanic and 151 772 [74%] Black) compared with an age-based approach (438 423 [68%] Hispanic, 154 714 [75%] Black). Overall, the PROVID and joint CRS/PROVID risk-based strategies were estimated to be followed by the most patients from areas with high neighborhood deprivation index being vaccinated early. CONCLUSIONS AND RELEVANCE: In this simulation modeling study of adults from a large integrated health care delivery system, risk-based strategies were associated with the largest estimated reductions in COVID-19 hospitalizations, deaths, and household transmissions compared with the CDC proxy and age-based strategies, with a higher proportion of Hispanic and Black patients were estimated to be vaccinated early in the process compared with the CDC strategy. 0.00193 max(0,(COPS2-10)) 3 -0.00259 max(0,(COPS2-20)) 3 0.00069 max(0,(COPS2-50)) 3 -3.3E-05 Age 0.05617 Age 2 0.00172 Age 3 -3E-05 max(0,(Age-30)) 3 3.3E-05 max(0,(Age-50)) 3 2.1E-05 max(0,(Age-65)) 3 Provide an explicit statement of the broader context for the study. Page 5 Present the study question and its relevance for health policy or practice decisions. Page 5 Target population and subgroups 4 Describe characteristics of the base case population and subgroups analyzed, including why they were chosen. Page 9 Discount rate 9 Report the choice of discount rate(s) used for costs and outcomes and say why appropriate. NA Describe what outcomes were used as the measure(s) of benefit in the evaluation and their relevance for the type of analysis performed. Page 7 Single study-based estimates: Describe fully the design features of the single effectiveness study and why the single study was a sufficient source of clinical effectiveness data. Describe all analytical methods supporting the evaluation. This could include methods for dealing with skewed, missing, or censored data; extrapolation methods; methods for pooling data; approaches to validate or make adjustments (such as half cycle corrections) to a model; and methods for handling population heterogeneity and uncertainty. Pages 9-10 Report the values, ranges, references, and, if used, probability distributions for all parameters. Report reasons or sources for distributions used to Page 10, Table 1 and Appendix A represent uncertainty where appropriate. Providing a table to show the input values is strongly recommended. For each intervention, report mean values for the main categories of estimated costs and outcomes of interest, as well as mean differences between the comparator groups. If applicable, report incremental cost-effectiveness ratios. Characterizing uncertainty 20a Single study-based economic evaluation: Describe the effects of sampling uncertainty for the estimated incremental cost and incremental effectiveness parameters, together with the impact of methodological assumptions (such as discount rate, study perspective). Risk-adjusting hospital mortality using a comprehensive electronic record in an integrated health care delivery system. Med Care Risk Adjusting Hospital Inpatient Mortality Using Automated Inpatient, Outpatient, and Laboratory Databases. Medical Care The Kaiser Permanente inpatient risk adjustment methodology was valid in an external patient population American Community Survey 5-Year Estimates, Table B03002