A randomized trial of at-home COVID-19 tests, telemedicine, and rapid prescription delivery for immunocompromised individuals

Background: COVID-19 continues to impose substantial risks to people who are immunocompromised and over 65 years old. Objective: Using a randomized control trial, we evaluated whether access to at-home COVID-19 tests, telemedicine, and same-day prescription delivery could reduce COVID cases, hospitalizations, and the cost of COVID care for the high-risk populations. Design: Individuals participated remotely, half (n = 346) receiving the option to access 10 at-home COVID-19 tests per month for themselves and others in their household as well as telemedicine and same-day Paxlovid delivery, and half following their standard testing and treatment practices (n = 325). Data sources: Outcome data were collected from surveys, electronic health records (EHR) and claims. Results: Intensive care unit (ICU) admissions were significantly reduced for intervention participants vs. control participants, (0.3% vs 4.6%, p < 0.001). COVID case incidence did not significantly differ (19.0% vs 20.4%, p = 0.69), nor did hospitalizations (5.2% vs 7.7%, p = 0.14). The intervention was estimated to result in a reduction of $3,650 in the cost of COVID care per person. Limitations: The specific intervention used is no longer available in the market and alternatives should be considered. Evolution of SARS-CoV-2 could change the effect observed. Survey completion is higher in the intervention group. Conclusions: In immunocompromised individuals and those at least aged 65 years, access to at-home COVID tests, telemedicine, and rapid Paxlovid delivery reduced the severity of COVID-19 infections, as reflected by a reduced need for ICU care; this has the potential to reduce the cost of COVID care.