Cost-Effectiveness Analysis of COVID-19 Vaccination in Low- and Middle-Income Countries

Figures & data

Table 1 Search Methods and Strategies

Database	Search Terms
PubMed	Concept 1 = COVID-19 “Covid-19”[Mesh] OR “Covid-19”[tiab] OR “SARS-CoV-2”[Mesh] OR “SARS-CoV-2”[tiab] OR “SARS Coronavirus 2”[tiab] OR “COVID”[tiab] OR “Coronavirus Disease-19”[tiab] OR “2019-nCoV”[tiab] OR “2019 Novel Coronavirus”[tiab] OR “Covid-19”[tw] OR “SARS-CoV- 2”[tw] OR “SARS Coronavirus 2”[tw] OR “COVID”[tw] OR “Coronavirus Disease-19”[tw] OR “2019-nCoV”[tw] OR “2019 Novel Coronavirus”[tw] Concept 2 = Vaccines “vaccine*”[Mesh] OR “vaccine*”[tiab] OR “vaccination*”[tiab] OR “immunization*”[tiab] OR “immunization*”[tw] OR “immunization*”[Mesh] OR “vaccine*”[tw] OR “vaccination*”[tw] Concept 3 = Cost-effectiveness “cost effectiveness”[tiab] OR “cost-effectiveness”[tiab] OR “cost effectivity*” [tiab] OR “cost- benefit analysis”[Mesh] OR “cost-effectiveness”[tw] “cost effectivity*” [tw] Final search terms: ((“Covid-19”[Mesh] OR “Covid-19”[tiab] OR “SARS-CoV-2”[Mesh] OR “SARS-CoV-2”[tiab] OR “SARS Coronavirus 2”[tiab] OR “COVID”[tiab] OR “Coronavirus Disease- 19”[tiab] OR “2019-nCoV” OR “2019 Novel Coronavirus”[tiab]) AND (“vaccine*”[Mesh] OR “vaccine*”[tiab]) AND (“cost effectiveness”[tiab] OR “cost-effectiveness”[tiab] OR “cost effectivity*” [tiab] OR “cost-effectivity*” OR “cost-benefit analysis”[Mesh])) AND 2021/01/01:2021/12/03[pdat]) NOT “review”[PT]
EBSCO	Concept 1 = COVID-19 TI (“Covid-19” OR “SARS-CoV-2” OR “SARS Coronavirus 2” OR “COVID” OR “Coronavirus Disease-19” OR “2019-nCoV” OR “2019 Novel Coronavirus”) OR AB (“Covid- 19” OR “SARS-CoV-2” OR “SARS Coronavirus 2” OR “COVID” OR “Coronavirus Disease- 19” OR “2019-nCoV” OR “2019 Novel Coronavirus”) OR TX (“Covid-19” OR “SARS-CoV- 2” OR “SARS Coronavirus 2” OR “COVID” OR “Coronavirus Disease-19” OR “2019-nCoV” OR “2019 Novel Coronavirus”) Concept 2 = Vaccines TI (vaccine* OR vaccination*) OR AB (“vaccine* OR vaccination*) OR TI (immunization*) OR AB (immunization*) OR TX (vaccine* OR vaccination*) OR TX (immunization*) Concept 3 =Cost-effectiveness TI (“cost effectiveness” OR “cost-effectiveness” OR “cost effectivity*” OR “cost-effectivity*”) OR AB (“cost effectiveness” OR “cost-effectiveness” OR “cost effectivity*” OR “cost- effectivity*”) OR TX (“cost effectiveness” OR “cost-effectiveness” OR “cost effectivity*” OR “cost-effectivity*”) Final search terms: (TI (“Covid-19” OR “SARS-CoV-2” OR “SARS Coronavirus 2” OR “COVID” OR “Coronavirus Disease-19” OR “2019-nCoV” OR “2019 Novel Coronavirus”) OR AB (“Covid-19” OR “SARS-CoV-2” OR “SARS Coronavirus 2” OR “COVID” OR “Coronavirus Disease-19” OR “2019-nCoV” OR “2019 Novel Coronavirus”)) AND (TI (vaccine* OR vaccination*) OR AB (“vaccine* OR vaccination*)) AND (TI (“cost effectiveness” OR “cost-effectiveness” OR “cost effectivity*” OR “cost-effectivity*”) OR AB (“cost effectiveness” OR “cost-effectiveness” OR “cost effectivity*” OR “cost-effectivity*”))

Figure 1 The article’s selection process.

Table 2 Study Characteristics

Author	Title	Year	Country	Objective	Data Collection and Analytical Method
Reddy et al^Citation13	Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa	2021	South Africa	Estimate the clinical and economic outcomes of COVID-19 vaccination programs in South Africa.	This modelling study involved the use of published or publicly available data. No primary data were collected for this study. The incremental cost-effectiveness ratio (ICER) in health care costs (2020 USD) divided by the difference in years of life saved (YLS).
Pearson et al^Citation14	COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness	2021	Pakistan	To project the health and the economic impact of different vaccination scenarios in Sindh Province, Pakistan.	Projection of cases, deaths, and hospitalization outcomes over 10 years under different vaccine scenarios. Economic model presented as incremental costs (from healthcare and partial societal perspectives), disability-adjusted life years (DALYs), and incremental cost-effectiveness ratio (ICER) for each scenario.
Hagens et al^Citation15	COVID-19 vaccination scenarios: A cost-effectiveness analysis for Turkey	2021	Turkey	To estimate the cost-effectiveness of strategies for COVID-19 vaccinations for Turkey by using mathematical modelling in various potential scenarios.	ICER was presented in cost per QALY gained. Effectivity for vaccination of COVID-19 was compared with no COVID-19 vaccination. WTP threshold was set at one GDP.
Suphanchai mat et al^Citation16	Prioritization of the target population for COVID-19 vaccination program in Thailand	2021	Thailand	To determine which policy is the most cost-effective in selecting the target population for COVID-19 vaccine administration.	Using ICER/one case averted, using ICER/one life saved, ICER/one baht GDP. Using secondary data from DDC, NHSO, NSO.

Table 3 Methodological Characteristics

Author	Perspective	Comparison	Time Horizon	Economic Model	Parameter of Sensitivity Analysis
Reddy et al^Citation13	Policymaker perspective	Comparing vaccination with no vaccination program	1 year	Dynamic microsimulation COVID-19 model - CEACOV	Vaccine acceptance; vaccine effectiveness in preventing infection, mild/moderate disease, and severe/critical disease requiring hospitalization; cost; initial prevalence of COVID-19 disease; initial reproduction number; prior immunity; reduction in transmission rate among vaccinated but infected individuals; and hospital and ICU daily costs. ICERs were also examined when the relatively high costs of ICU care were excluded and when all hospital care costs were excluded. Multi-way sensitivity analyses were performed in which parameters influential in one-way sensitivity analyses were simultaneously varied.
Pearson et al^Citation14	Healthcare and partial societal perspective	Comparing vaccination with no vaccination	10 years	Bayesian inference via Markov Chain Monte Carlo	Comorbidities, discounting of DALYs, campaign duration, and duration of natural immunity.
Hagens et al^Citation15	Healthcare perspective and social perspective	Comparing vaccination with no vaccination (mask-wearing and social distancing were assumed to be uniform)	1 year	Dynamic transmission model	Vaccine costs, QALYs lost, ICU cost, hospitalization cost, percentage population being susceptible, friction period, non-productive period, and case fatality rate.
Suphanch aimat et al^Citation16	Provider perspective	Comparing vaccination with no vaccination vs Policy A (allocate vaccines to low-risk Thais), Policy B (allocate vaccines to high-risk migrants and to low-risk Thais), Policy C (high-risk migrants and unregister migrants then low-risk Thais), and Policy D (high-risk migrants and unregister migrants then low-risk migrants)	30–60 days	Susceptible- Exposed- Infected- Recovered (SEIR) compartment combined with the system dynamics model as a base framework	Reproduction number and vaccine effectiveness.

Table 4 Cost Elements

Author	Cost Estimation
Reddy et al^Citation13	Cost per person vaccinated, hospital and ICU cost.
Pearson et al^Citation14	Vaccination and immunization cost COVID-19 diagnosis and treatment.
Hagens et al^Citation15	Direct costs included the health care costs of hospitalization, the ICU stay, and pharmacotherapy at home and vaccination. Indirect costs included production losses due to sickness leave and premature death.
Suphanchaimatet al^Citation16	Treatment unit cost and vaccination cost.

Table 5 Primary Results

Author	Result
Reddy et al^Citation13	We found that a COVID-19 vaccination program would reduce infections and deaths, and likely reduce overall health care costs (in ICERs of $520/YLS) in South Africa across a range of possible scenarios, even with conservative assumptions around vaccine effectiveness.
Pearson et al^Citation14	At 1-year distribution, $3/dose vaccine yielded 70% efficacy and 2.5-year duration of protection is likely to avert around 0.9 (95% credible interval (CrI): 0.9, 1.0) million cases, 10.1 (95% CrI: 10.1, 10.3) thousand deaths, and 70.1 (95% CrI: 69.9, 70.6) thousand DALYs, with an ICER of $27.9 per DALY. COVID-19 vaccination is highly cost-effective and cost-saving in Sindh Province, Pakistan, if the vaccine prices < $10/dose and the infection occurs in the short term (not more than 5 years or lifelong). The results see less benefit to initially prioritizing vaccination of older (65+) populations compared to unprioritized distribution.
Hagens et al^Citation15	Vaccination is cost-effective if the vaccine’s efficiency in preventing transmission is equal to or less than 50% of its effectiveness in preventing transmission with an ICER $511/QALY and $1045/QALY.
Suphanchaimatet al^Citation16	The result is divided into three categories: Cost-effectiveness analysis by different policy scenarios. Cost-effective in Policy D with ICER −1.0/one baht GDP Cost-effectiveness analysis by varying reproduction numbers. Cost-effective in policy D with ICER 14.2/one baht GDP Cost-effectiveness analysis by varying vaccine effectiveness. Cost-effective in policy D with ICER −1.2/one baht GDP

Reddy KP, Fitzmaurice KP, Scott JA, et al. Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa. medRxiv. 2021;2021.05.07.21256852. doi:10.1101/2021.05.07.21256852

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Pearson CAB, Bozzani F, Procter SR, et al.; CHiL COVID-19 Working Group; CMMID COVID-19 Working Group. COVID-19 vaccination in Sindh Province, Pakistan: a modelling study of health impact and cost-effectiveness. PLoS Med. 2021;18(10):e1003815. doi:10.1371/journal.pmed.1003815

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Hagens A, Inkaya AÇ, Yildirak K, et al. COVID-19 vaccination scenarios: a cost-effectiveness analysis for Turkey. Vaccines. 2021;9(4):399. doi:10.3390/vaccines9040399

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Suphanchaimat R, Tuangratananon T, Rajatanavin N, Phaiyarom M, Jaruwanno W, Uansri S. Prioritization of the target population for coronavirus disease 2019 (COVID-19) Vaccination Program in Thailand. Int J Environ Res Public Health. 2021;18(20):10803. doi:10.3390/ijerph182010803

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