APPENDIX A:

SSM Health Risk Stratification Methodology for Monoclonal Antibody

Bamlanivimab and casirivimab/imdevimab infusions recently received Emergency Use Authorization by

the FDA. Bamlanivimab and casirivimab/imdevimab are monoclonal antibodies indicated for use in high
risk outpatients with mild/moderate COVID-19 to prevent hospitalization. The System AMS/ID
committee have developed a risk stratification system and scoring methodology created by the analyst
team within SSM Health based off the Utah Hospital Association and Utah Health Risk Stratification
criteria. This risk stratification system utilizes discrete criteria to determine patients at highest risk of
hospitalization and allocation of bamlanivimab and casirivimab/imdevimab to those at highest risk.

Given that bamlanivimab and casirivimab/imdevimab are more efficacious when administered earlier in
the disease course, administration should occur within 5 days of symptom onset.

Patient Selection Criteria

General Inclusion – for patients 12 years or older
• Laboratory-confirmed COVID-19 (PCR)
• Symptomatic, with no more than 5 days from symptom onset
• Positive Covid test within the last 4 days
• High Risk for Hospitalization based on Risk Stratification
Exclusion Criteria (any of the following):
• New Hypoxemia (SpO2<92% on room air or receiving new/increased
supplemental oxygen
• Being admitted or already admitted to an acute care hospital
• Pregnancy (inadequate safety data)
• Positive antibody test
*See Risk Stratification Tool section below
COVID-19 Risk Scoring Methodology
Demographic Risk Factors Points

Male 2

Age 3 for every decade:

12-19=3, 20-29=6, 30-39=9, 40-49=12, 50-
59=15, 60-69=18, 70-79=21, 80-89=24,
9099=27 30

Non-White Race or Hispanic/Latinx Ethnicity 7

Highest-Risk Comorbidities

Diabetes mellitus 3

Obesity (BMI>35) 1

Other High-Risk Comorbidities

Hypertension 1

Asthma 1

Symptom Risk Factor

New Shortness of Breath 4

Total

Ethical Justification for Using Race/Ethnicity in Patient Selection: COVID-19 has had a disproportionate
impact on low income communities and certain racial/ ethnic minorities in the United States. Equity calls
attention to the systematic differences in health outcomes and opportunities to be healthy that
adversely affect socially discounted and/or marginalized groups. For COVID-19, these inequities may
arise from higher burdens of preexisting comorbid disease, poor health care access, or not having the
option for social distancing due to living in densely populated neighborhoods or households. There are
also more economically disadvantaged individuals working essential jobs during the pandemic, and many
are unable to perform job functions from the safety of their home. This puts them at greater risk of
interacting with others who may transmit COVID-19. Public health interventions may be used to attempt
to mitigate these disparities in COVID-19 by recognizing the structural inequities that underlie them. One
way to do this is to include race/ethnicity in the patient selection criteria.