China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China.
China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
Int J Infect Dis. 2022 Jun;119:87-94. doi: 10.1016/j.ijid.2022.03.029. Epub 2022 Mar 22.
To evaluate the cost-effectiveness of a booster strategy in the United States.
We developed a decision-analytic Markov model of COVID-19 to evaluate the cost-effectiveness of a booster strategy of the Pfizer-BioNTech BNT162b2 (administered 6 months after the second dose) among older adults from a healthcare system perspective.
Compared with 2 doses of BNT162b2 without a booster, the booster strategy in a 100,000 cohort of older adults would incur an additional cost of $3.4 million in vaccination cost but save $6.7 million in direct medical cost and gain 3.7 quality-adjusted life-years in 180 days. This corresponds to a benefit-cost ratio of 1.95 and a net monetary benefit of $3.4 million. Probabilistic sensitivity analysis indicates that a booster strategy has a high chance (67%) of being cost-effective. Notably, the cost-effectiveness of the booster strategy is highly sensitive to the population incidence of COVID-19, with a cost-effectiveness threshold of 8.1/100,000 person-day. If vaccine efficacies reduce by 10%, 30%, and 50%, this threshold will increase to 9.7/100,000, 13.9/100,000, and 21.9/100,000 person-day, respectively.
Offering the BNT162b2 booster to older adults aged ≥65 years in the United States is likely to be cost-effective. Less efficacious vaccines and boosters may still be cost-effective in settings of high SARS-CoV-2 transmission.
评估美国加强针策略的成本效益。
我们开发了一种 COVID-19 的决策分析马尔可夫模型，从医疗保健系统的角度评估了为老年人提供辉瑞-生物科技 BNT162b2（在第二剂后 6 个月给予）加强针策略的成本效益。
与两剂 BNT162b2 无加强针相比，在 10 万例老年人队列中，加强针策略将在疫苗接种成本上额外增加 340 万美元，但在直接医疗成本上节省 670 万美元，并在 180 天内获得 3.7 个质量调整生命年。这相当于收益成本比为 1.95，净货币收益为 340 万美元。概率敏感性分析表明，加强针策略有很高的可能性（67%）具有成本效益。值得注意的是，加强针策略的成本效益对 COVID-19 的人群发病率高度敏感，成本效益阈值为每 10 万人 8.1 天。如果疫苗效力降低 10%、30%和 50%，则该阈值将分别增加到每 10 万人 9.7、13.9 和 21.9 天。
为美国 65 岁及以上的老年人提供 BNT162b2 加强针可能具有成本效益。在 SARS-CoV-2 传播率较高的情况下，效力较低的疫苗和加强针可能仍然具有成本效益。
