Keeling Matt J, Hill Edward M, Petrou Stavros, Tran Phuong Bich, Png May Ee, Staniszewska Sophie, Clark Corinna, Hassel Katie, Stowe Julia, Andrews Nick
The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK.
Civic Health Innovation Labs and Institute of Population Health, University of Liverpool, Liverpool, L69 7ZX, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, L69 7ZX, UK.
Vaccine. 2025 Apr 19;53:126948. doi: 10.1016/j.vaccine.2025.126948. Epub 2025 Mar 1.
In England, and many other countries, immunity to SARS-CoV-2 infection and COVID-19 disease is highly heterogeneous. Immunity has been acquired through natural infection, primary and booster vaccination, while protection has been lost through waning immunity and viral mutation. During the height of the pandemic in England, the main aim was to rapidly protect the population and large supplies of vaccine were pre-purchased, eliminating the need for cost-effective calculations. As we move to an era where for the majority of the population SARS-CoV-2 infections cause relatively mild disease, and vaccine stocks need to be re-purchased, it is important we consider the cost-effectiveness and economic value of COVID-19 vaccination programmes. Here using data from 2023 and 2024 in England on COVID-19 hospital admissions, ICU admissions and deaths, coupled with bespoke health economic costs, we consider the willingness to pay threshold for COVID-19 vaccines in different age and risk groups. Willingness to pay thresholds vary from less than £1 for younger age-groups without any risk factors, to over £100 for older age-groups with comorbidities that place them at risk. This extreme non-linear dependence on age, means that despite the different method of estimating vaccine effectiveness, there is considerable qualitative agreement on the willingness to pay threshold, and therefore which ages it is cost-effective to vaccinate. The historic offer of COVID-19 vaccination to those 65 and over for the autumn 2023 programme and those over 75 for the spring 2023 programme, aligns with our cost- effective threshold for pre-purchased vaccine when the only cost was administration. However, for future programmes, when vaccine costs are included, the age-thresholds slowly increase thereby demonstrating the continued importance of protecting the eldest and most vulnerable in the population.
在英国以及许多其他国家，对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染和新冠病毒病（COVID-19）的免疫力存在高度异质性。免疫力通过自然感染、初次和加强疫苗接种获得，而保护作用则因免疫力减弱和病毒变异而丧失。在英国疫情高峰期，主要目标是迅速保护民众，预先购买了大量疫苗，无需进行成本效益计算。随着我们进入一个大多数人感染SARS-CoV-2只会引发相对轻症的疾病的时代，且需要重新购买疫苗库存，考虑COVID-19疫苗接种计划的成本效益和经济价值就变得很重要。在此，我们利用2023年和2024年英国关于COVID-19住院、重症监护病房（ICU）收治情况及死亡的数据，结合定制的卫生经济成本，来考量不同年龄和风险群体对COVID-19疫苗的支付意愿阈值。支付意愿阈值从无任何风险因素的较年轻年龄组的不到1英镑，到有合并症且处于风险中的老年年龄组的超过100英镑不等。这种对年龄的极端非线性依赖意味着，尽管估计疫苗效力方法不同，但在支付意愿阈值方面存在相当大的定性共识，因此也就知道了对哪些年龄组进行疫苗接种具有成本效益。2023年秋季针对65岁及以上人群以及2023年春季针对75岁以上人群提供COVID-19疫苗接种，这与我们在仅考虑接种管理成本时预先购买疫苗的成本效益阈值相符。然而，对于未来计划，当纳入疫苗成本时，年龄阈值会缓慢上升，从而表明持续保护人群中年龄最大和最脆弱群体的重要性。
