This article should be read in conjunction with this article ‘How effective is Evusheld?‘. This may help with your decision making.
Evusheld (tixagevimab/cilgavimab) is available privately in the UK. Here is what we know about how to access it. We advise that you speak to your medical team before considering this treatment.
If accessing a private practitioner remember to ensure that they are GMC registered and for a clinical specialty that has experience in the management of patients who are immune compromised or immune suppressed and that they routinely give and manage other monoclonal and polyclonal antibody therapies and are conversant in managing unexpected or adverse events. These would include the specialities Immunology, Rheumatology and Renal Medicine, for example.
What is Evusheld?
Evusheld (tixagevimab/cilgavimab) is a treatment made by the pharmaceutical company AstraZeneca. It is given by intra-muscular injection. It is an antibody treatment that can be used to help prevent people at high risk of developing serious health complications from getting COVID-19 in the first place. This makes it an option for people with immunodeficiency who may not have had a good response to the COVID-19 vaccines.
Medical opinion on the usefulness of Evusheld to protect people with primary and secondary immunodeficiency against COVID-19 is divided especially considering Evusheld’s waning effectiveness against the emerging new variants of COVID-19. Even when variants are susceptible, this is at a lower level than for the original COVID-19 strain and therefore the duration of protection given by Evusheld may be 8-12 weeks or less.
Many clinicians believe that the best protection for patients is keeping up to date with their COVID-19 vaccinations and the presence of anti-COVID-19 antibodies in immunoglobulin (IG) products*. However, many patients place a high value on Evusheld as a means of providing an extra layer of protection against COVID-19 so that they can lead less-restrictive lives.
*Although Immunodeficiency UK is aware of increasing levels of anti-COVID-19 antibodies in immunoglobulin products there is no consensus on what levels provide protection against COVID-19 and we are unable to give specific information on what levels are present in the different commercial products and their different batches. Some immunology centres are routinely testing IG products and may be able to offer patients more information.
Can I buy Evusheld privately in the UK?
In October 2022, Immunodeficiency UK were told by AstraZeneca that they have decided to make Evusheld available privately in the UK, effective from 19th October 2022. This means people can pay to have it, but it is not available free on our NHS. Their Medical Information and Patient Safety (MIPS) team is on hand to answer both patient and clinical questions: medical.informationUK@astrazeneca.com or call 0800 783 0033.
We know many people will not be able to afford this treatment privately, and for others it will mean making difficult financial choices. This is not the way Immunodeficiency UK wants Evusheld to become available. We believe access to Evusheld and, indeed, any other approved prophylactic anti-COVID-19 protective treatment that is developed in the future, should be based on clinical need, not wealth. That’s why Immunodeficiency UK is part of the Forgotten550K campaign and are still lobbying the government to make Evusheld available on the NHS.
How much does Evusheld cost?
Evusheld (tixagevimab/cilgavimab) will cost a private healthcare provider £1,000 per dose. There is then VAT on top – £200. Each dose is 600mg (containing 300mg of tixagevimab and 300mg of cilgavimab). This is the recommended dose for an individual person.
While the private provider will pay £1,200 per dose, they will need to charge their patients more than this. There might be a charge for the consultation, plus the charge for administering the treatment. This means the cost to patients will be over £1,200. It’s not possible to say exactly how much, as it will depend on how much the provider decides to charge. One CVID patient who has accessed Evusheld through a London clinic was charged an additional £500 for the doctor consultation and then £180 for administering the injection. So the total cost may be in the order of £2,600.
How can I access Evusheld and where can I get it?
You will need a prescription from a relevant healthcare professional to get Evusheld. Speak to your medical team to see if they can give you a prescription. If not, you may have to try and access it through a private consultation with a doctor (see below).
Once you have a prescription, there are various places you may be able to access Evusheld, but this depends on who in the private sector is offering it.
AstraZeneca have already spoken to major health insurance providers, private healthcare providers and private hospitals. We don’t know exactly which ones have agreed to offer Evusheld. But what we do know is below.
Once you have a prescription for Evusheld, it’s possible you could get it from:
- Private health insurance – if you already have private health insurance, then you would need to ask your provider if they are able to offer you Evusheld.
- Private healthcare companies – private healthcare providers (Bupa for example) offer some treatments privately even if you don’t have their insurance. You’d need to ask the provider if they can offer you Evusheld.
- Private hospitals or clinics – private medical centres may offer Evusheld. Some NHS hospitals also have departments that deliver private care. You’d need to contact each private hospital or clinic to see whether they would offer you Evusheld.
How is Evusheld given?
Evusheld (tixagevimab/cilgavimab) is given as two separate injections – 300mg of tixagevimab and 300mg of cilgavimab. The injections are given into a muscle.
Evusheld needs to be prepared and given to you by a qualified healthcare professional in a sterile method and environment, where you can also be observed for any signs of reaction afterwards. Please see our recommendations above.
You should also be given advice as to your subsequent COVID-19 risk levels and any steps you should continue to take to minimise risk of infection noting that Evusheld does not offer full protection and lacks efficacy against new variants (link to article).
Who is eligible for private access to Evusheld?
Evusheld is licensed in the UK to prevent COVID-19 in adults (over 18s) who:
- are unlikely to mount an adequate immune response to COVID-19 vaccination, or
- for whom COVID-19 vaccination is not recommended.
You need a prescription from a healthcare professional to access Evusheld. If your doctor thinks you fit either criterion above, for example because you have an immunodeficiency and remain at high risk of developing severe health complications from getting COVID-19, they may write you a prescription.
Is Evusheld effective?
Evusheld was tested in clinical trials that ended in August 2021. It was shown to be highly effective at preventing infection with COVID-19, and also at reducing the risk of severe disease and the chance of hospitalisation after an infection.
It’s important to understand that Evusheld can’t completely remove the risk of catching COVID-19 or getting seriously ill with COVID-19. Even after treatment with Evusheld, people will need to remain aware of the risks.
Evusheld targets a part of the virus that can mutate over time, as new covid variants emerge. This means that new mutations can increase or decrease Evusheld’s effectiveness. Since the clinical trials ended, Evusheld has been rolled out in other countries, and data from patients in those countries suggests that it‚Äôs effective against variants including Omicron BA.1 and BA.2. There’s less data available against BA.4 and BA.5, and no real-world data available against many of the variants circulating in November 2022, such as BQ.1, BQ.1.1, BA.2.75.2 and others. To find out which variants are circulating in the UK, you can look at the weekly ONS infection survey results.
In the absence of real-world data, modelling and laboratory testing is used to predict whether Evusheld will be effective against certain variants. Currently, one study using laboratory testing suggests that Evusheld has reduced or no effectiveness against some newer variants including BQ.1, BQ.1.1, XBB and others, some of which are expected to become the dominant variants in the UK. Because these variants are so new, this is the first study that has tested Evusheld against them. More studies will be published soon.
For now, this recent study raises the question of how effective Evusheld is against the newer variants.
Are there any conditions or treatments that mean you can’t have Evusheld?
Evusheld is not licensed to give if you are hypersensitive or allergic to any of the ingredients.
Do I need Evusheld every 6 months?
Clinical trials found that a 600mg dose of Evusheld (tixagevimab/cilgavimab) was effective for 6 months. Therefore, AstraZeneca advises repeating the treatment every 6 months to continue the protection it provides. However, there have not been any clinical trials looking at further doses at 6 months. We do not know if there will be an increase in cost for this treatment going forward.
If I have Evusheld, and then I get COVID-19 can I still take the post-exposure covid treatments (antivirals or antibodies)?
There haven’t been any studies looking at specific interactions with other drugs or medicines. Therefore, there are no particular treatments or medicines that you are advised to avoid after receiving Evusheld.
If you test positive for COVID-19, you should know how to access COVID-19 treatments. Make sure you tell your medical health team too, especially if you’ve also had Evusheld.
What next if I want to access Evusheld?
Talk to your medical health team about this treatment, to ensure it’s the right thing for you. They might also have important advice about the timing of treatments or vaccines. If you don’t have a specialist hospital team, speak to your GP.
We will continue to update this web page as we learn more about access to Evusheld.
Posted 23rd November 2022