COVID | Free Full-Text | Evusheld Prophylaxis Improves Social Interactions, Anxiety, Depression, Agoraphobia, and Quality of Life in Blood Cancer Patients

In total, 29/40 Evusheld patients and 54/100 control patients responded to the questionnaire. With three Evusheld patients, the drug was paid for by the insurance company/employer, but for 37/40 the drug was self-funded. For the control patients, 44% were aware of Evusheld but chose not to have the drug, with cost being the majority reason cited. The majority of control patients (56%) were not aware of Evusheld, primarily because they had not discussed the drug with their managing hematologist. Analysis of EQ5D data (Supplementary Table S1) showed that Evusheld did not impact ‘mobility’, ‘self-care’, or ‘pain/discomfort’ scores, and patient and control groups scored at similar levels. Evusheld did, however, improve the ‘usual activities’ and ‘anxiety/depression’ scores of EQ5D, with 48.3% of patients reporting some level of problem completing usual activities pre-Evusheld, decreasing to 18.5% post-Evusheld (p = 0.02). The control group reported 21.8%. Similarly, pre-Evusheld, 55.2% of patients suffered from some level of anxiety/depression, decreasing to 32.1% post-Evusheld (p = 0.03) (control = 34.5%). Additionally, the EQ5D mean measure of global health increased from 68.5% to 75.5% following Evusheld treatment (p = 0.03) (control = 75.7%). Overall, therefore, Evusheld treatment was associated with a statistically significant benefit in three of five EQ5D dimensions using chi-squared analysis and an improved global health score using a paired t-test. Of note, after Evusheld treatment, all EQ5D scores were highly similar to the baseline scores of the non-Evusheld control group using chi-squared analysis.

Evusheld also showed improvements in the DSM5 agoraphobia score (Supplementary Table S2), reducing the mean score from 15.7/40 pre-Evusheld to 5.1/40 post-Evusheld (p p p Figure 1) suggesting that even though Evusheld improved the willingness to enter crowded situations, the Evusheld patients remained more concerned about this key marker of social interaction compared with control patients.

The DSSI score (Supplementary Table S3) showed that the mean number of interactions with external household contacts (social/work) increased from 1.48 external interactions in the 3 weeks pre-Evusheld to 3.37 in the 3-weeks post-Evusheld (p Figure 2a). Indeed, in the 3-weeks pre-Evusheld, 52% of patients had no social interactions outside of their household, which reduced to 20% of patients in the 3-weeks post-Evusheld (p = 0.002) which was statistically similar to the control group (17%; Figure 2b). Furthermore, the average total score from the 14 HADS domains was 24.7 (a score of 14 = no change following Evusheld treatment), with 25.4% of scores ranks as “significantly improved” and 25.4% ranked as “a little improved” with Evusheld treatment (Supplementary Table S4). The HADS domain ranked as the most improved with Evusheld was “I look forward with enjoyment to things” with 45% of patients ranking this as “significantly improved”. The HADS domain that changed the least with Evusheld treatment was “I have lost interest in my appearance” with 72% of patients reporting no difference with Evusheld treatment.

Free-text comments from patients showed an overwhelmingly positive impact of Evusheld, with most comments highlighting improved QoL/social mobility and their belief that Evusheld should be more widely accessible (Supplementary Table S5). Indeed, when control patients were asked why they did not have Evusheld, 42.6% said their decision was financially motivated to some extent (Supplementary Table S6). Similarly, 26.9% of control patients stated they would have had Evusheld if it had been covered by their private health insurer or the NHS.