Proof‐of‐concept calculations to determine the health‐adjusted life‐year trade‐off between intravitreal anti‐VEGF injections and transmission of COVID ‐19
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Abstract
Background
Clinical ophthalmological guidelines encourage the assessment of potential benefits and harms when deciding whether to perform elective ophthalmology procedures during the COVID‐19 pandemic, in order to minimize the risk of disease transmission.
Method
We performed probability calculations to estimate COVID‐19 infection status and likelihood of disease transmission among neovascular age‐related macular degeneration patients and health‐care workers during anti‐VEGF procedures, at various community prevalence levels of COVID‐19. We then applied the expected burden of COVID‐19 illness and death expressed through health‐adjusted life‐years (HALYs) lost. We compared these results to the expected disease burden of severe visual impairment if sight protecting anti‐VEGF injections were not performed.
Results
Our calculations suggest a wide range of contexts where the benefits of treatment to prevent progression to severe visual impairment or blindness are greater than the expected harms to the patient and immediate health care team due to COVID‐19. For example, with appropriate protective equipment the benefits of treatment outweigh harms when the chance of progression to severe visual impairment is >0.044% for all scenarios where COVID‐19 prevalence was 1/1000, even when the attack rate in the clinical setting is very high (5‐43%).
Conclusion
Unless COVID‐19 prevalence is very high, the reduced disease burden from avoiding visual impairment outweighs the expected HALYs lost from COVID‐19 transmission. This finding is driven by the fact that HALYs lost when someone suffers severe visual impairment for 5 years are equivalent to nearly 400 moderate cases of infectious disease lasting 2 weeks each.
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SciScore for 10.1101/2020.04.27.20075085: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization This model accounts for the true background prevalence of COVID-19 disease in the community, and therefore the probability that health care workers or the patient (drawn randomly from the population) are currently infected, the probability of transmission among these individuals at the time of treatment based on attack rate data, the health impact in terms of vision impairment, COVID-19 infection, and life years lost due to death from COVID-19. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did …
SciScore for 10.1101/2020.04.27.20075085: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization This model accounts for the true background prevalence of COVID-19 disease in the community, and therefore the probability that health care workers or the patient (drawn randomly from the population) are currently infected, the probability of transmission among these individuals at the time of treatment based on attack rate data, the health impact in terms of vision impairment, COVID-19 infection, and life years lost due to death from COVID-19. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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