Economic value of vaccines to address the COVID-19 pandemic: a U.S. cost-effectiveness and budget impact analysis

Figures & data

Figure 1. Markov model of disease progression with coronavirus disease 2019 (COVID-19). Patients progressed through a modified “SEIR” process (susceptible-exposed-infected-recovered). This model was used to conduct both the cost-effectiveness analysis and the budget impact model. The infection phases were staged from 0 through 4 in terms of increasing escalation, including the use of critical care services. Patients who did not recover from COVID-19 died. Model alternatives to doing nothing included treatment and vaccination to avoid entry into the infected phases.

Figure 2. Tornado diagram of one-way sensitivity analysis for parameter variabilities with the greatest impact on study results. Abbreviations: ICER, Incremental cost-effectiveness ratio; QALY, Quality-adjusted life year.

Table 1. Model parameters.

Parameter	Expected value	Range for sensitivity analysis		Source
		Lower bound	Upper bound
Infection population statistics
U.S. population	330 million
Probability of social contact (b)	0.053			^21
Social contacts per person (c)	7.00	5.25	8.75	^22
Basic reproduction number (r0)	2.26	1.70	2.83	^15
Social contacts per person with social distancing	3.00			Assumed
Transition probabilities
S to E	0.307	0.000	1.00	^21
E to I	0.00023	0.004	0.006	^1^,^21
I to I0	0.250	0.000	0.929	^23
I0 to R^a	1.000			Assumed
I to I1^a	0.750
I1 to I2^a	0.191
I1 to R	0.809	0.000	1.000	^24
I2 to I3	0.314	0.000	1.000	^25
I2 to R^a	0.686
I3 to I4	0.115	0.000	0.531	^25
I3 to R^a	0.530
I3 to death	0.350	0.000	0.084	^1^,^25^,^26
I4 to R^a	0.650
I4 to death	0.350	0.000	0.426	^1^,^25^,^26
Effect modifiers of interventions
Vaccine efficacy	0.900	0.675	1.000	Assumed
Proportion vaccinated	0.600	0.450	0.750	^27
Risk reduction from herd immunity	0.500	0.000	1.000	Assumed
Daily costs (USD 2020)
I1 costs
Sick day	$122.86	$92.15	$153.58	^28
Medications	$0.95	$0.71	$1.19	^29^,^30
I2 costs
Sick day	$252.87	$189.65	$316.09	^28
Medications	$5.07	$3.80	$6.34	^29^,^31
Primary care visit and tests	$1,248.70	$936.53	$1,560.88	^32
Urgent care visit and tests	$1,553.38	$1,165.04	$1,941.73	^32
Emergency care visit and tests	$9,253.25	$6,939.94	$11,566.56	^32
I3 and I4 costs
Primary care visit, tests and x-ray	$8,850.19	$6,637.64	$11,062.74	^32
Urgent care visit, tests and x-ray	$9,143.51	$6,857.63	$11,429.39	^32
Emergency care visit, tests and x-ray	$16,843.31	$12,632.48	$21,054.14	^32
Hospital bed (I3)	$1,432.57	$1,074.43	$1,790.71	^33
ICU bed (I4)	$3,898.85	$2,924.14	$4,873.56	^33
Vaccination cost	$65.87	$49.40	$82.34	^34
Utilities (QALYs)
Utility of susceptible (S)	0.880	0.018	1.000	^35^,^36
Utility of exposed (E)	0.880	0.018	1.000	^36
Utility of infected (I)	0.833	0.017	1.000	^36
Utility of asymptomatic (I0)	0.833	0.017	1.000	^36
Utility of mild symptoms (I1)	0.614	0.012	1.000	^21
Utility of moderate symptoms (I2)	0.500	0.010	0.990	^36
Utility of severe symptoms (I3)	0.250	0.005	0.495	^36
Utility of critical care (I4)	0.050	0.001	0.099	^36
Utility of death	0.000			Anchor
Utility of recover (R)	0.880	0.018	1.000	^35^,^36
Utility with vaccine	0.900	0.018	1.000	^35^–^37

^aRemainder from 1.0.

Abbreviations. S, Susceptible; E, Exposed; I, Infection; R, Recovered; ICU, Intensive Care Unit.

Table 2. Cost-effectiveness analysis comparing vaccination to no intervention to address the U.S. COVID-19 pandemic.

Comparator	Cost ($)	dCost ($)	Effectiveness (QALYs)	dEffectiveness (dQALYs)	ICER ($/QALY)	Program cost ($ Billions)	Budget impact ($ per person)
Do nothing	102	–	0.879	–	–	33.797	102
Vaccination	86	–16	0.899	0.020	Dominates	13.042	40

Abbreviations. ICER, Incremental cost-effectiveness ratio; QALY, Quality-adjusted life year; dCost, Difference in cost; dEffectiveness, Difference in effectiveness; dQALYs, Difference in QALYs.

Dominates indicates that the alternative is preferred at a lower cost and higher effectiveness relative to “Do Nothing”.

Figure 3. Cost-effectiveness acceptability curve of the probability that a comparator is cost-effective at a given cost-effectiveness threshold, based on results of a probabilistic sensitivity analysis of 10,000 Monte Carlo simulations. Abbreviation. QALY, Quality-adjusted life year.

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Data availability statement

All model data are available upon request by the study authors.