Abstract
BackgroundResearchers are working at unprecedented speed to develop a SARS-CoV-2 vaccine. We aimed to assess the value of a hypothetical vaccine and its potential public health impact when prioritization is required due to supply constraints. MethodsA Markov cohort model was used to estimate COVID-19 related direct medical costs and deaths in the United States (US), with and without implementation of a 60% efficacious vaccine. To prioritize the vaccine under constrained supply, the population was divided into tiers based on age; risk and age; and occupation and age; and outcomes were compared across one year under various supply assumptions. The incremental cost per quality-adjusted life-year (QALY) gained versus no vaccine was calculated for the entire adult population and for each tier in the three prioritization schemes. ResultsThe incremental cost per QALY gained for the US adult population was $8,200 versus no vaccination. For the tiers at highest risk of complications from COVID-19, such as those ages 65 years and older, vaccination was cost-saving compared to no vaccination. The cost per QALY gained increased to over $94,000 for those with a low risk of hospitalization and death following infection. Results were most sensitive to infection incidence, vaccine price, the cost of treating COVID-19, and vaccine efficacy. Under the most optimistic supply scenario, the hypothetical vaccine may prevent 31% of expected deaths. As supply becomes more constrained, only 23% of deaths may be prevented. In lower supply scenarios, prioritization becomes more important to maximize the number of deaths prevented. ConclusionsA COVID-19 vaccine is predicted to be good value for money (cost per QALY gained <$50,000). The speed at which an effective vaccine can be made available will determine how much morbidity and mortality may be prevented in the US.
Highlights
The novel coronavirus (SARS-CoV-2) was first identified in humans in late 2019
As of November 30, 2020 there were over 63 million cases of novel coronavirus disease 2019 (COVID-19) confirmed worldwide, with approximately 20% of these cases reported in the United States (US) [1]
During the course of the infection, could be as high as $163.4 billion [2]. This estimate does not include medical costs related to postinfection care or worsening of unrelated diseases due to postponement of preventive care and diagnosis, non-medical costs such as productivity losses due to absenteeism and premature mortality, or declines in economic activity. In response to this global health emergency, researchers are working at unprecedented speed to find an effective vaccine and there are at least twenty potential candidates being tested in human clinical trials [3]
Summary
The novel coronavirus (SARS-CoV-2) was first identified in humans in late 2019. As of November 30, 2020 there were over 63 million cases of novel coronavirus disease 2019 (COVID-19) confirmed worldwide, with approximately 20% of these cases reported in the United States (US) [1]. During the course of the infection, could be as high as $163.4 billion [2] This estimate does not include medical costs related to postinfection care or worsening of unrelated diseases due to postponement of preventive care and diagnosis, non-medical costs such as productivity losses due to absenteeism and premature mortality, or declines in economic activity. In response to this global health emergency, researchers are working at unprecedented speed to find an effective vaccine and there are at least twenty potential candidates being tested in human clinical trials [3].
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