COVID-19 Treatment Trends in U.S. Veterans

COVID-19 has led to the development of various antiviral medications aimed at helping patients recover and reducing the chances of severe illness. In the United States, several treatments have been approved for veterans who test positive for the virus but are not hospitalized. These include ritonavir-boosted nirmatrelvir, remdesivir, and Molnupiravir. These medications became available for use under emergency authorization from the FDA between December 2021 and January 2022.

By April 2023, about 8.9 million courses of Nirmatrelvir-ritonavir and approximately 1.3 million courses of molnupiravir had been given to veterans. However, there are still significant barriers preventing many at-risk veterans from receiving these treatments. Information on how these treatments have been used more than a year after their approval is also limited.

#Veterans Health Administration and Its Role

The Veterans Health Administration (VHA) is the largest healthcare system in the U.S. and serves millions of veterans each year. It operates numerous medical centers and outpatient facilities. The VHA has a system for distributing COVID-19 treatments through its pharmacies, making it possible to analyze how these medications have been provided to veterans diagnosed with COVID-19.

This study aims to look at the trends and factors that influenced how COVID-19 treatments were prescribed to veterans from January 2022 to January 2023. The focus is on nirmatrelvir-ritonavir, molnupiravir, and certain Monoclonal Antibodies used during this timeframe.

#How Data was Collected

Data for this study came from the VA's COVID-19 Shared Data Resource. This resource brings together various data sources to give a detailed picture of COVID-19 among veterans. Positive SARS-CoV-2 tests are tracked using the VA National Surveillance Tool, which collects information about veterans who test positive either within the VHA system or from outside sources documented in their medical records.

Records for COVID-19 treatments were gathered from several sources: the VA Corporate Data Warehouse, Medicare claims data for veterans who also use Medicare, and claims data for monoclonal antibodies available through VA Community Care. This analysis covered data until September 30, 2022, and used the Corporate Data Warehouse to gather demographic and clinical information about the patients.

#Study Population

The study focused on veterans aged 18 and older who tested positive for SARS-CoV-2 between January 1, 2022, and January 31, 2023. Only veterans who had at least one outpatient primary care visit in the 18 months before their positive test and who were not hospitalized around that time were included.

The study examined various demographic factors such as race, ethnicity, age, and geographic location. It also looked at underlying health conditions, smoking status, and vaccination status.

#Types of COVID-19 Treatments

The study identified veterans who received nirmatrelvir-ritonavir, molnupiravir, or specific monoclonal antibodies. Due to changing virus variants, some treatments like sotrovimab and bebtelovimab were no longer authorized after April 2022. While remdesivir was approved for outpatient use, it was not included as a separate treatment group due to difficulties in distinguishing between outpatient and inpatient administration.

Veterans were categorized based on the first treatment they received within seven days of testing positive. Those who did not receive treatment were placed in a "no treatment" group.

#Statistical Analysis

The analysis calculated the proportions of veterans prescribed various COVID-19 treatments over time. It also looked at factors that affected whether a veteran received any treatment. Statistical models were used to determine the impact of demographic factors like age, gender, race, and health status on treatment likelihood.

#Key Findings

Between January 2022 and January 2023, over 285,000 veterans tested positive for SARS-CoV-2. The number of veterans who received COVID-19 treatment increased significantly from January 2022, reaching a peak in August 2022 before slightly declining by early 2023.

Of those who tested positive, only 9.3% received nirmatrelvir-ritonavir, 3.2% received molnupiravir, and 1.7% received monoclonal antibodies. The majority, 83.8%, did not receive any treatment. Most prescriptions were identified from the VHA system.

#Trends in Treatment Over Time

The percentage of veterans receiving treatment rose from 3.2% in January to 23.9% in August 2022, but fell back to 20.8% by January 2023. Nirmatrelvir-ritonavir saw the most use, but the prescribing rate for this medication decreased over time. In contrast, use of molnupiravir grew as certain monoclonal antibodies were no longer authorized.

#Regional Variations in Treatment

There were large differences in treatment rates based on geographic location. Some regions showed higher rates of nirmatrelvir-ritonavir prescriptions compared to molnupiravir. Factors influencing these variations included local policies and healthcare resources.

#Factors Influencing Treatment Distribution

Several factors were linked to receiving COVID-19 treatment. Older veterans and those with more underlying health issues were more likely to receive treatment, along with Black and Hispanic veterans. Conversely, veterans living in rural areas, those who smoke, and those with substance use disorders were less likely to receive treatment.

#Observations about Racial and Ethnic Disparities

Initially, Black and Hispanic veterans were less likely to receive COVID-19 treatment. However, over time, this trend has changed, showing progress in reaching these populations. Compared to non-veteran groups, racial and ethnic disparities in treatment seem to be less pronounced within the VA system.

#Limitations of the Study

It is important to consider the study's limitations. Researchers could not fully determine whether veterans were symptomatic at the time of their positive tests, which might have influenced treatment eligibility. The study also lacked data on treatments given outside the VHA, especially for younger veterans not enrolled in Medicare.

Another limitation is that data from certain external sources were only available until September 2022. This might have affected the overall analysis, but the failure to capture every treatment provided does not undermine the larger trends observed.

#Conclusion

In summary, among veterans who tested positive for COVID-19 from January 2022 to January 2023, treatment rates increased significantly until August 2022 before slightly declining. Nirmatrelvir-ritonavir remained the most prescribed treatment, despite drops in its use. The study highlighted demographic and geographic disparities in treatment, with improvements noted for Black and Hispanic veterans over time. Continued efforts are needed to ensure that high-risk individuals receive the care they require. Future research should focus on evaluating the effectiveness of available COVID-19 treatments among different groups of veterans.