Quadrant Health Economics Inc., Cambridge, ON, Canada.
Moderna, Inc., Cambridge, MA, USA.
J Med Econ. 2023 Jan-Dec;26(1):1532-1545. doi: 10.1080/13696998.2023.2281083. Epub 2023 Nov 27.
To assess the potential clinical impact and cost-effectiveness of COVID-19 mRNA vaccines updated for fall 2023 in adults aged ≥18 years over a 1-year analytic time horizon (September 2023-August 2024).
A compartmental Susceptible-Exposed-Infected-Recovered model was updated to reflect COVID-19 cases in summer 2023. The numbers of symptomatic infections, COVID-19-related hospitalizations and deaths, and costs and quality-adjusted life-years (QALYs) gained were calculated using a decision tree model. The incremental cost-effectiveness ratio (ICER) of a Moderna updated mRNA fall 2023 vaccine (Moderna Fall Campaign) was compared to no additional vaccination. Potential differences between the Moderna and the Pfizer-BioNTech fall 2023 vaccines were also examined.
Base case results suggest that the Moderna Fall Campaign would decrease the expected 64.2 million symptomatic infections by 7.2 million (11%) to 57.0 million. COVID-19-related hospitalizations and deaths are expected to decline by 343,000 (-29%) and 50,500 (-33%), respectively. The Moderna Fall Campaign would increase QALYs by 740,880 and healthcare costs by $5.7 billion relative to no vaccine, yielding an ICER of $7700 per QALY gained. Using a societal cost perspective, the ICER is $2100. Sensitivity analyses suggest that vaccine effectiveness, COVID-19 incidence, hospitalization rates, and costs drive cost-effectiveness. With a relative vaccine effectiveness of 5.1% for infection and 9.8% for hospitalization for the Moderna vaccine versus the Pfizer-BioNTech vaccine, use of the Moderna vaccine is expected to prevent 24,000 more hospitalizations and 3300 more deaths than the Pfizer-BioNTech vaccine.
As COVID-19 becomes endemic, future incidence, including patterns of infection, are highly uncertain. The effectiveness of fall 2023 vaccines is unknown, and it is unclear when a new variant that evades natural or vaccine immunity will emerge. Despite these limitations, our model predicts the Moderna Fall Campaign vaccine is highly cost-effective across all sensitivity analyses.
在 1 年的分析时间范围内（2023 年 9 月至 2024 年 8 月），评估针对 18 岁及以上成年人的 2023 年秋季更新的 COVID-19 mRNA 疫苗的潜在临床影响和成本效益。
我们更新了一个隔室易感-暴露-感染-恢复模型，以反映 2023 年夏季的 COVID-19 病例。使用决策树模型计算了症状感染、与 COVID-19 相关的住院和死亡人数、成本和质量调整生命年（QALY）。比较了 Moderna 更新的 2023 年秋季 mRNA 疫苗（Moderna Fall Campaign）与不进行额外接种的增量成本效益比（ICER）。还研究了 Moderna 和辉瑞-BioNTech 2023 年秋季疫苗之间的潜在差异。
基础病例结果表明，Moderna Fall Campaign 将使预期的 6420 万例有症状感染减少 720 万例（11%），降至 5700 万例。与 COVID-19 相关的住院和死亡人数预计将分别下降 34.3 万例（29%）和 5 万例（33%）。与不接种疫苗相比，Moderna Fall Campaign 将增加 74.088 万 QALY，并增加 57 亿美元的医疗保健成本，导致每获得一个 QALY 的增量成本效益比为 7700 美元。从社会成本的角度来看，ICER 为 2100 美元。敏感性分析表明，疫苗效力、COVID-19 发病率、住院率和成本是影响成本效益的因素。与辉瑞-BioNTech 疫苗相比，Moderna 疫苗对感染的疫苗效力为 5.1%，对住院的疫苗效力为 9.8%，使用 Moderna 疫苗预计将预防 24000 例以上的住院和 3300 例以上的死亡。
随着 COVID-19 成为地方病，未来的发病率，包括感染模式，具有高度的不确定性。秋季 2023 年疫苗的有效性尚不清楚，也不清楚何时会出现逃避自然或疫苗免疫的新变种。尽管存在这些限制，但我们的模型预测，在所有敏感性分析中，Moderna Fall Campaign 疫苗都具有很高的成本效益。
