Public health impact of the Pfizer-BioNTech COVID-19 vaccine (BNT162b2) in the first year of rollout in the United States

Figures & data

Figure 1. Structure of the Markov model.

Figure 2. Decision tree for the probabilities of COVID-19 symptoms and sequelae.

Table 1. Model Parameters.

Category	Input description	Base Case						Scenario	References
		12–17 yrs	18–29 yrs	30–49 yrs	50–64 yrs	65–74 yrs	75+ yrs	5–11 yrs
Infection inputs	Population with infection-induced immunity at the start (%)	16.9	16.9	12.3	9.4	6.1	6.1	16.3	^29
	Annual attack rate (%)	15.5	31.9	31.9	24.9	16.1	16.1	15.5	^42
	Variant distribution (%)	Original: 21.6; Alpha: 16.9; Gamma: 1.8; Delta: 59.7							^43
	Duration of protection from infection-induced immunity	9 months							^44^,^45
Vaccine inputs	Dose 1 vaccine coverage (%)	22.6	30.2	34.1	40.3	50.8	49.6	3.7	^37
	Dose 2 vaccine compliance (%)	81.5	80.1	81.7	85.3	88.2	87.5	63.5	^46
	Vaccine-induced duration of protection	Dose 1: 6 months; Dose 2: 12 months							^44
	Vaccine effectiveness (VE)	Described in S8
Clinical inputs	Probabilities of symptoms and sequelae	Described in S9
Direct costs in the acute phase	COVID test (USD)	42							^47
	Number of tests/case (outpatient/inpatient/ICU)	1 / 2 / 2							^33
	GP visit number/ cost (USD)	2 / 229							Visit number:^33 Cost:^15
	OTC pain medication (USD)	4.5							Walgreen OTC cost assumption
	In-patient treatment (USD)
	General ward (without/with IMV)	14,325 / 41,769						10,915/ 26,332	5–11:^31 12+:^31
	ICU (without/with IMV)	25,688 / 78,245						25,727/ 89,392
Direct costs of sequelae	PASC treatment cost (USD)^a	2,319							a^31
	% of patients readmitted	9%							^48
	Mean cost of hospitalization for those re-admitted^b	14,655							b^31
	GP visit number / case	4							^31
	Number of tests / case	2							^31
Indirect costs	Productivity loss estimation	Described in S13
QALY outcomes	Health utilities	Described in S14

Abbreviations. COVID-19, coronavirus disease 2019; ICU, intensive care unit; IMV, invasive mechanical ventilation; GP, general physician; OTC, over the counter; PASC, post-acute sequelae of COVID-19; QALY, quality-adjusted life year; USD, United States dollar; VE, vaccine effectiveness.

^aWeighted average of 0–11 readmission cost PREMIER Pfizer data on file, and 12+ inpatient, no IMV cost from Di Fusco et al., 2021.

^bMean Cost calculated based on mean charges divided by charge to cost ratio of specific progression cohort).

Table 4. Sensitivity analysis.

Variables	Symptomatic cases averted		Deaths averted		Hospitalizations averted		Direct care costs (USD)		Productivity loss (USD)
	N (% difference)		N (% difference)		N (% difference)		N (% difference)		N (% difference)
Base case in subjects ≥12	8,663,085	N/A	111,380	N/A	689,797	N/A	$30.4	N/A	$43.7	N/A
Burden of disease parameters
Infection-induced immunity
2020 reported cases (CDC COVID Tracker^54)	9,361,160	8.1%	114,262	2.6%	718,232	4.1%	$32.1	5.7%	$46.6	6.8%
Attack Rate
2021 reported cases (CDC COVID Tracker^54)	3,195,642	–63.1%	40,899	–63.3%	251,882	–63.5%	$11.2	–63.3%	$15.6	–64.2%
2020 reported cases (CDC COVID Tracker^54)	2,410,245	–72.2%	36,959	–66.8%	212,403	–69.2%	$9.0	–70.4%	$11.9	–72.8%
CDC burden of disease estimates adjusted for under-reporting^2	8,302,981	–4.2%	112,542	1%	682,096	–1.1%	$29.7	–2.3%	$41.4	–5.3%
Variant distribution
KPSC MMWR (Malden et al.^56)	8,603,033	–0.7%	110,866	–0.5%	686,709	–0.4%	$30.1	–0.8%	$43.2	–1.1%
Probability of symptoms
CDC pandemic planning scenarios, 70% across age groups^57	7,184,740	–17.1%	95,391	–14.4%	583,748	–15.4%	$27.2	–10.7%	$39.8	–8.8%
Hospitalization rate (S10)
CDC pandemic planning scenarios^57	8,664,544	0.0%	56,612	–49.2%	326,909	–52.6%	$21.2	–30.3%	$37.0	–15.3%
EPIC-HR study in high-risk adults^58	8,663,589	0.0%	89,962	–19.2%	653,192	–5.3%	$28.8	–5.4%	$43.2	–1.2%
TOGETHER study in high-risk adults^59	8,660,912	0.0%	158,278	42.1%	1,541,614	123.5%	$49.7	63.4%	$68.6	57.1%
CDC burden of disease estimates^2	8,663,943	0.0%	79,716	–28.4%	470,930	–31.7%	$24.9	–18.1%	$39.5	–9.5%
COMET-ICE study in high-risk adults^60	8,663,831	0.0%	70,659	–36.6%	689,559	0.0%	$28.9	–4.8%	$46.5	6.6%
Outpatient mortality
Rosenthal et al.,^61 0.6% across age groups	8,661,368	0.0%	142,200	27.7%	689,760	0.0%	$30.4	0.0%	$67.8	55.3%
Infection-induced duration of protection^44
6 months	9,130,214	5.4%	114,442	2.7%	713,972	3.5%	$31.7	4.3%	$45.8	5.0%
12 months	8,364,956	–3.4%	109,441	–1.7%	674,369	–2.2%	$29.6	–2.7%	$42.3	–3.2%
Target population
Inclusion of year-end rollout in 5–11 age group (S2–14)	8,709,595	0.5%	111,386	0.0%	689,808	0.0%	$30.5	0.2%	$43.7	0%
Vaccine effectiveness parameters
Delta VE from Nasreen et al.,^62 instead of Tartof et al.,^63	9,745,867	12.5%	124,279	11.6%	771,855	11.9%	$34.1	12.1%	$49.1	12.4%
Vaccine-induced duration of protection^44
Dose 1: 4 months	7,578,033	–12.5%	97,746	–12.2%	603,920	–12.4%	$26.6	–12.5%	$38.3	–12.4%
Dose 2: 10 months
Dose 1: 5 months	8,171,442	–5.7%	105,396	–5.4%	651,710	–5.5%	$28.7	–5.6%	$41.2	–5.5%
Dose 2: 11 months
Dose 1: 9 months	9,053,401	4.5%	115,367	3.6%	717,008	3.9%	$31.7	4.1%	$45.6	4.3%
Dose 2: 12 months
Dose 1: 7 months	9,087,336	4.9%	116,094	4.2%	720,997	4.5%	$31.8	4.7%	$45.7	4.8%
Dose 2: 13 months
Dose 1: 8 months	9,464,319	9.2%	120,277	8.0%	748,745	8.5%	$33.1	8.8%	$47.6	9.1%
Dose 2: 14 months
Healthcare resource use and cost parameters
Hospitalization cost
Median values (vs mean values) (S11)^31	8,663,085	0.0%	111,380	0.0%	689,797	0.0%	$27.2	–11%	$43.7	0.2%
Outpatient care (# and cost of GP, test, medications)
Lower GP visit ($112)^15 and test cost/case ($35)^64	8,663,085	0.0%	111,380	0.0%	689,797	0.0%	$26.6	−12.5%	$43.7	0.0%
Higher GP cost/case (ED visit: $582)^15	8,663,085	0.0%	111,380	0.0%	689,797	0.0%	$41.4	36.3%	$43.7	0.0%
PASC care
Lower re-admission: 4%^48	8,663,085	0.0%	111,380	0.0%	689,797	0.0%	$27.6	–9.2%	$43.7	0.0%
Higher re-admission: 15%^48	8,663,085	0.0%	111,380	0.0%	689,797	0.0%	$33.8	11.2%	$43.7	0.0%
PASC cost and resource use −10%	8,663,085	0.0%	111,380	0.0%	689,797	0.0%	$29.5	–2.9%	$43.7	0.0%
PASC cost and resource use +10%	8,663,085	0.0%	111,380	0.0%	689,797	0.0%	$31.3	2.9%	$43.7	0.0%
Additional care management costs
Adverse events requiring hospital care (S12)	8,663,085	0.0%	111,380	0.0%	689,797	0.0%	$28.6	–5.9%	$43.7	0.0%
Vaccine Administration costs ($40 per dose)^65	8,663,085	0.0%	111,380	0.0%	689,797	0.0%	$22.7	–25.2%	$43.7	0.0%
Vaccine Administration & acquisition costs ($60 per dose)^65^,^66	8,663,085	0.0%	111,380	0.0%	689,797	0.0%	$19.0	–37.4%	$43.7	0.0%

Abbreviations. CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019; ED, emergency department; GP, general physician; PASC, post-acute sequelae of COVID-19; USD, United States dollar; VE, vaccine effectiveness.

Table 2. Estimated burden of disease in the absence of COVID-19 vaccination.

Outcomes	“Low” scenario	Base case	“High” scenario
Symptomatic cases, n	42,171,670	59,507,414	89,332,715
Deaths, n	323,950	497,001	809,834
Outpatient cases, n	39,869,272	56,041,320	83,776,394
Hospitalizations, n	2,302,398	3,466,094	5,556,321
General ward without IMV	1,696,424	2,555,808	4,100,063
General ward with IMV	99,736	149,710	239,488
ICU without IMV	215,747	324,707	519,978
ICU with IMV	290,491	435,870	696,792
QALY lost, discounted	3,790,162	5,742,161	9,234,445
Cost outcomes, USD
Direct costs (billions)	$108.0	$180.9	$302.4
Productivity loss (billions)	$193.3	$278.9	$426.5

Abbreviations. ICU, intensive care unit; IMV, invasive mechanical ventilation; LY, life year; QALY, quality-adjusted life year; USD, United States dollar.

Table 3. Total cumulative number of health outcomes averted by BNT162b2, and associated cost-savings.

Outcomes	“Low” scenario	Base case	“High” scenario
Symptomatic cases, n	5,033,511	8,663,085	13,853,033
Deaths, n	45,760	111,380	202,797
Outpatient cases, n	4,771,447	7,973,287	12,590,046
Hospitalizations, n	262,065	689,797	1,262,987
General ward without IMV	189,680	501,191	918,794
General ward with IMV	12,401	32,104	58,512
ICU without IMV	24,876	65,279	119,376
ICU with IMV	35,108	91,223	166,305
QALY lost, discounted	489,548	1,144,091	2,056,257
Cost outcomes, USD
Direct costs (billions)	$12.7	$30.4	$57.4
Productivity loss (billions)	$22.4	$43.7	$73.3

Abbreviations. ICU, intensive care unit; IMV, invasive mechanical ventilation; LY, life year; QALY, quality-adjusted life year; USD, United States dollar.

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Availability of data and materials

Data generated or analyzed during this study are available upon request.