1. Be aware of usage rates for Bamlanivimab, REGEN-CoV, and Bamlanivimab-Etesevimab in the MHS between 2020-2022.
2. Identify potential disparities based on race, age, and socioeconomic status in mAb usage within the MHS during the COVID-19 pandemic and discuss the implications of these inequities.
3. Suggest potential measures to reduce differences in mAb usage such as outreach, policy changes, and increased accessibility.
In the early stages of the COVID-19 pandemic, monoclonal antibodies (mAbs) were identified as a potential therapeutic option to reduce severe morbidity and mortality from COVID-19 infection. Between 2020 and 2021, the FDA granted emergency authorization of Bamlanivimab, REGEN-CoV, and Bamlanivimab-Etesevimab as treatments for mild to moderate COVID-19 in patients at high risk of severe illness, hospitalization, or death. Despite governmental efforts to distribute mAbs equitably among underprivileged populations in the U.S., multiple studies of healthcare system data have found significant disparities in mAb usage by race, socioeconomic status, and sex. To date, no studies have examined whether the disparities in mAb usage identified in the civilian population also existed within the Military Health System (MHS). In this context, we examined mAb usage rates across various demographic and socioeconomic groups within the MHS population. We conducted a cross-sectional study of TRICARE beneficiaries, ages 12 and above, who were eligible for mAb treatment between November 10, 2020 and January 24, 2022. Using TRICARE claims data from the MHS Data Repository (MDR), we identified administration of Bamlanivimab, REGEN-CoV, and Bamlanivimab-Etesevimab during the specified period. Treatment eligibility was determined using guidelines provided by each mAb’s manufacturer, which included factors such as COVID-19 diagnosis and the presence of certain high-risk conditions. We compared rates of mAb usage by race, socioeconomic status, and sex among this population. During the study period, a total of 221,036 individuals received a COVID-19 diagnosis. Among those with a COVID-19 diagnosis, 9,907 (4.5%) received mAb treatment. 90% of those who received mAb treatment were seen within the private care sector of the MHS. Among those who obtained mAb treatment, 53% were White, 64% were 45-64 years old, 57% were female, 77% were in an Enlisted rank, and 56% were dependents. 86% of those who received mAbs were not classified as high risk for severe illness from COVID-19, based on criteria such as high BMI and presence of chronic diseases. Our findings revealed that only a small portion of individuals with a COVID-19 diagnosis received mAb treatment during the study period. A large percentage of those receiving mAb treatment were seen within the private care sector and were mainly dependents and retirees. Despite established guidelines for the administration of mAbs, a significant portion of those who received mAbs within our study population did not meet the criteria for high-risk. Further logistic regression analysis will be conducted to assess the likelihood of receiving mAb treatment by the aforementioned factors. The analysis will help to highlight whether there were significant disparities in mAb usage within a universally insured population. Disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, assertions, opinions or policies of the Uniformed Services University of the Health Sciences (USUHS), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), the Department of Defense (DoD), or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.