Health Economics and Epidemiology Research Office (HE(2)RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Modelling and Simulation Hub, Africa (MASHA), University of Cape Town, Cape Town, South Africa; Centre for Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom.
Vaccine. 2024 Aug 13;42(20):125988. doi: 10.1016/j.vaccine.2024.05.036. Epub 2024 May 31.
COVID-19 vaccines were rolled out in South Africa beginning in February 2021. In this study we retrospectively assessed the cost-effectiveness of the vaccination programme in its first two years of implementation.
We modelled the costs, expressed in 2021 US$, and health outcomes of the COVID-19 vaccination programme compared to a no vaccination programme scenario. The study was conducted from a public payer's perspective over two time-horizons - nine months (February to November 2021) and twenty-four months (February 2021 to January 2023). Health outcomes were estimated from a disease transmission model parameterised with data on COVID-19-related hospitalisations and deaths and were converted to disability adjusted life years (DALYs). Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted to assess parameter uncertainty.
Incremental cost-effectiveness ratio (ICER) was estimated at US$1600 per DALY averted during the first study time horizon. The corresponding ICER for the second study period was estimated at US$1300 per DALY averted. When 85% of all excess deaths during these periods were included in the analysis, ICERs in the first and second study periods were estimated at US$1070 and US$660 per DALY averted, respectively. In the PSA, almost 100% of simulations fell below the estimated opportunity cost-based cost-effectiveness threshold for South Africa (US$2300 DALYs averted). COVID-19 vaccination programme cost per dose had the greatest impact on the ICERs.
Our findings suggest that South Africa's COVID-19 vaccination programme represented good value for money in the first two years of rollout.
南非于 2021 年 2 月开始推出 COVID-19 疫苗。在本研究中，我们回顾性评估了该疫苗接种计划在实施的头两年的成本效益。
我们构建了模型，以 2021 年的美元为单位，比较了 COVID-19 疫苗接种计划与不接种疫苗计划的成本和健康结果。本研究从公共支付者的角度，在两个时间范围内进行，九个月（2021 年 2 月至 11 月）和二十四个月（2021 年 2 月至 2023 年 1 月）。通过使用与 COVID-19 相关住院和死亡数据参数化的疾病传播模型来估计健康结果，并将其转换为残疾调整生命年（DALY）。进行确定性和概率敏感性分析（DSA 和 PSA）以评估参数不确定性。
在第一个研究时间范围内，每避免一个 DALY 的增量成本效益比（ICER）估计为 1600 美元。第二个研究期间的相应 ICER 估计为每避免一个 DALY 的 1300 美元。当将这两个时期的所有超额死亡人数的 85%纳入分析时，第一个和第二个研究期间的 ICER 估计分别为每避免一个 DALY 的 1070 美元和 660 美元。在 PSA 中，几乎 100%的模拟结果都低于南非估计的基于机会成本的成本效益阈值（每避免一个 DALY 的 2300 美元）。COVID-19 疫苗接种计划的每剂成本对 ICER 影响最大。
我们的研究结果表明，南非的 COVID-19 疫苗接种计划在实施的头两年具有良好的成本效益。
