Clinical impact and cost-effectiveness of the updated COVID-19 mRNA Autumn 2023 vaccines in Germany

Figures & data

Table 1. Comparative vaccine effectiveness of the updated mRNA vaccines.

	Infection (%)		Severe disease (%)
	VE	Waning	VE	Waning
mRNA-1273.815 vaccine	57.1	4.8	84.3	1.4
XBB.1.5 BNT162b2 vaccine	54.8	4.8	82.6	1.4

Abbreviation. VE, vaccine effectiveness.

Figure 1. Incidence of symptomatic SARS-CoV-2 infection with and without mRNA-1273.815 vaccine, by alternative assumptions of vaccine effectiveness waning and month.

Table 2. Resource utilisation and cost parameters.

Non-hospitalized care
Proportion seeking outpatient care^a (%)			15.8%
Hospitalization Rates (%)
Age (years)	Unvaccinated^b	No ICU or ventilation^c	ICU only^c	ICU with ventilation^c	Mortality (overall)^d
0–4	1.3	92.9	0.0	7.1	0.0
5–17	0.5	77.2	21.2	1.6	0.1
18–29	0.7	84.7	8.1	7.2	0.1
30–39	1.2	77.2	9.6	13.1	0.2
40–49	1.6	69.8	11.2	19.1	0.5
50–59	1.7	69.8	11.2	19.1	2.4
60–69	8.4	59.2	12.6	28.3	1.9
70–79	11.1	59.2	12.6	28.3	6.6
≥80	16.9	73.2	13.5	13.3	7.0
Endemic vaccination-related costs^e			€119
Cost of outpatient care^f			€122.02
Hospitalization costs, by level of care^43
No ICU or ventilation^c			€6,900
ICU only^c			€27,981
ICU with ventilation^c			€38,500
Hospitalization recovery cost^g			€15.25

Abbreviation. ICU, intensive care unit.

^a Weighted average calculated from Robert Koch Institute⁴⁴.

^b Data represent 4th quarter of 2020 (to capture unvaccinated); estimates adjusted for Omicron^43–45.

^c Intensive care unit.

^d Data represent 1st quarter of 2023 (reflects Omicron²).

^e Assumption (vaccine €109 price to patient; administration fee €10⁴⁶. As price for XBB1.5 BNT162b2 was not available, same price as for mRNA-1273.815 was assumed.

^f Assumes 1.6 outpatient visits at a cost of €76.26 per visit^47,48.

^g Assumes 0.2 outpatient visits at a cost of €76.26 per visit^47,48.

Table 3. Utility values and QALY decrement due to events in the consequences decision tree.

Location of care	Disutility	Duration	QALY decrement	Source(s)
Short-term infection period
Not hospitalized	0.59	4.29 days	0.008	47,50,51
Hospitalized, no ICU or ventilator	0.425	9 days	0.010	47,51–53
Hospitalized, ICU	0.425	11.8 days	0.014
Hospitalized, ICU with ventilator	0.425	25.2 days	0.029
Recovery from hospitalization during the short-term infection period
No ICU or ventilator	0.0	0.0	0.00	Assumption^a
ICU	0.0	0.0	0.00
ICU with ventilator	0.0	0.0	0.00
Post-Infection
Not hospitalized			0.028	54
Hospitalized			0.122	55
Lifetime QALY loss due to mortality, discounted at 3%
0–4 years			29.46
5–17 years			28.29
18–29 years			26.10
30–39 years			23.45
40–49 years			20.37
50–59 years			16.71
60–69 years			12.65
70–79 years			8.40
≥80 years			3.14

Abbreviation. ICU, intensive care unit; QALY, quality-adjusted life-year.

^a All short-term quality-of-life impacts are assumed to be captured by the short-term infection period QALY decrements.

Table 4. Productivity and work loss parameters used in the model.

Model parameter	Value	Source
Labor force participation rates
0–4 years	0.0%	56
5–17 years	2.9%
18–29 years	69.4%
30–39 years	83.3%
40–49 years	86.4%
50–59 years	76.2%
60–69 years	47.7%
70–79 years	7.34%
≥80 years	0.0%
Average daily wage (€)
0–4 years	0.00	57
5–17 years	17.30
18–29 years	101.50
30–39 years	163.20
40–49 years	175.10
50–59 years	174.20
60–69 years	60.30
70–79 years	59.10
≥80 years	56.50
Workdays Lost for:
Vaccine Administration^a	0.18	58
Not Hospitalized	4.29	47 6 days with adjustment for weekend (multiplied by 5/7)
Hospitalized
No ICU or ventilator	9	53
ICU only	11.8	53
Ventilator	25.2	52
Hospitalization recovery	0	Assumption (no data available)

Abbreviations. ICU, intensive care unit; IQWIG, Institute for Quality and Efficiency in Health Care; US, United States.

^a Based on US data. Assumed that 30% of patients would receive the vaccine in the pharmacy, corresponding to 0.2 h of time lost, and the remaining 70% of patients would receive the vaccine in the physician’s office, corresponding to 2 h of time lost⁵⁷. Assuming an 8-h workday, 0.18 total workdays would be lost for vaccine administration.

Discount rate of 3% (Version 7 of the IQWiG general guidelines⁵⁹).

Life tables from Federal Statistical Office.

Table 5. Base-case cost-effectiveness of mRNA-1273.815 campaign vs no vaccination (healthcare payer perspective).

Vaccination strategy	Costs (€)	QALYs lost	Δ Costs (€)	Δ QALYs gained	ICER (Δ cost/QALY gained)
mRNA-1273.815 campaign	5,079,554,822	484,679	--	--
No vaccination	5,126,177,326	581,617	46,622,504	−96,938	mRNA-1273.815 Dominant

Abbreviations. ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year.

Figure 2. Deterministic sensitivity analyses of societal return on investment. VE, vaccine effectiveness.

Table 6. Base-case cost-effectiveness of mRNA-1273.815 campaign vs XBB.1.5 BNT1262b2 campaign (healthcare payer perspective).

Vaccination Strategy	Costs (€)	QALYs Lost	Δ Costs (€)	Δ QALYs Gained	ICER (Δ Cost/QALY Gained)
mRNA-1273.815 campaign	5,079,554,822	484,679	--	--
XBB.1.5 BNT162b2 campaign	5,138,327,691	489,356	58,772,869	−4,677	mRNA-1273.815 Dominant

Abbreviations. ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year.

Figure 3. Value-based price premium (mRNA-1273-815 vs XBB.1.5 BNT1262b2 vaccine) at various willingness-to-pay thresholds, by rVE scenario. Abbreviations. CI, confidence interval; LB, lower bound; QALY, quality-adjusted life-year; rVE, relative vaccine effectiveness; UB, upper bound.

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