Prosser Lisa A, Perroud Janamarie, Chung Grace S, Gebremariam Acham, Janusz Cara B, Mercon Kerra, Rose Angela M, Avanceña Anton L V, Kim DeLuca Ellen, Hutton David W
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; Susan B. Meister Child Health and Evaluation Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Vaccine. 2025 Feb 27;48:126725. doi: 10.1016/j.vaccine.2025.126725. Epub 2025 Jan 21.
Substantial investments by government programs and private health plans subsidized the costs of COVID-19 vaccine doses and vaccine administration. The objective of this study was to evaluate the cost-effectiveness of vaccination against COVID-19 illness during the initial year of COVID-19 vaccination (2021).
Using a simulation model, we projected outcomes for hypothetical cohorts of US adults aged 18 and older, stratified by age and risk status for complications, comparing vaccination and no vaccination in the context of recommended concomitant prevention strategies (e.g., masking, social distancing). Vaccination against COVID-19 illness and complications used a pooled vaccination strategy for the 3 products available in 2021. Primary outcome measures included incremental cost-effectiveness ratio (ICER), projected costs, and projected quality-adjusted life years (QALYs). The model was parameterized using US epidemiologic, clinical, and cost data and the analysis used the healthcare and societal perspectives.
For vaccination against COVID-19 illness compared with no vaccination, vaccination yielded cost savings and QALY gains for all adult age and risk groups using the societal perspective. Using a healthcare sector perspective, ages 18-39 years required a net investment with ICERs ranging from $8400 to $15,000/QALY. Scenarios evaluating vaccine incentive programs mostly yielded ICERs <$100,000/QALY except for worker bonuses of $500 which yielded ICERs of $22,000 to $134,000/QALY. Results were most sensitive to costs of vaccination (dose cost, administration cost, travel and vaccination time costs) across uncertainty analyses.
Investment in the 2021 vaccination program was attractive from an economic perspective even when using a very conservative approach to the analysis. Future vaccination programs in the US, with different associated cost structures, should be assessed to ensure ongoing value for COVID-19 vaccination.
政府项目和私人健康保险计划投入了大量资金，用于补贴新冠疫苗剂量和疫苗接种的费用。本研究的目的是评估2021年新冠疫苗接种首年针对新冠疾病进行疫苗接种的成本效益。
我们使用一个模拟模型，针对年龄在18岁及以上的美国成年人假设队列进行结果预测，按年龄和并发症风险状况分层，在推荐的伴随预防策略（如戴口罩、保持社交距离）背景下比较接种疫苗和未接种疫苗的情况。针对新冠疾病和并发症的疫苗接种采用了2021年可用的3种产品的联合接种策略。主要结果指标包括增量成本效益比（ICER）、预测成本和预测质量调整生命年（QALY）。该模型使用美国的流行病学、临床和成本数据进行参数设定，分析采用了医疗保健和社会视角。
从社会视角来看，与未接种疫苗相比，针对新冠疾病进行疫苗接种在所有成年年龄和风险组中均产生了成本节约和QALY增益。从医疗保健部门视角来看，18至39岁人群需要净投资，ICER范围为每QALY 8400美元至15000美元。评估疫苗激励计划的情景大多产生的ICER低于每QALY 100000美元，但500美元的工人奖金产生的ICER为每QALY 22000美元至134000美元。在所有不确定性分析中，结果对疫苗接种成本（剂量成本、接种成本、交通和接种时间成本）最为敏感。
即使采用非常保守的分析方法，2021年疫苗接种计划的投资从经济角度来看也是有吸引力的。应对美国未来具有不同相关成本结构的疫苗接种计划进行评估，以确保新冠疫苗接种持续具有价值。
