A Randomized Trial of At-Home COVID-19 Tests, Telemedicine, and Rapid Prescription Delivery for Immunocompromised Individuals

Objective

To evaluate 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 using a randomized controlled trial.

Patients and Methods

Individuals participated remotely between December 1, 2022, and May 16, 2024, with half (n=346, 51.5%) 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 (n=325, 48.4%) following their standard testing and treatment practices. Outcome data were collected from surveys, electronic health records and claims.

Results

Intensive care unit admissions were significantly reduced for intervention participants vs control participants (0.3% vs 4.6%, n=1 vs 13; P<.001). Reported COVID case incidence did not differ significantly (19.0% vs 20.4%, n=59 vs 58; P=.69), nor did hospitalizations (5.2% vs 7.7%, n=15 vs 22; P=.14). The intervention was estimated to result in a reduction of $3650 in the cost of COVID care per person. 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 was higher in the intervention group.

Conclusion

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 intensive care unit admissions; this has the potential to reduce the cost of COVID care.

Trial Registration

clinicaltrials.gov Identifier: NCT05655546