Document text
Economic analysis of an
additional dose of the
2024 -2025 COVID -19 vaccine
University of Michigan
COVID -19 Vaccination Modeling Team
Presentation to the Advisory Committee on Immunization Practices
October 23, 2024
1
Study team
University of Michigan
•Lisa A. Prosser, PhD, Principal Investigator
•David W. Hutton, PhD, Co -Investigator
•Acham Gebremariam, MS, Programmer/Analyst
•Angela Rose, MS, MPH, Project Manager
•Kerra Mercon, MS, Research Assistant
Wake Forest University
•Cara Janusz, PhDCenters for Disease Control and Prevention
•Jamie Pike, PhD, Health Economist, Project officer
•Megan Wallace, DrPH, Epidemiologist
•Ismael Ortega -Sanchez, PhD, Senior Economist
•Andrew Leidner, PhD, Economist
•Fangjun Zhou, PhD, Health Scientist
•Melisa Shah, MD, MPH, Medical Epidemiologist
•Danielle Moulia, MPH, Health Scientist
•Ruth Link -Gelles, PhD, Epidemiologist
•Sharon Saydah, PhD, Epidemiologist
2
Conflict of interest statement
3Authors have no known conflicts of interest.
Objectives
•Original aims*:
oEstimate annual disease burden and healthcare utilization associated with COVID -19
illness and COVID- 19 booster vaccination, including cases of symptomatic illness,
hospitalizations, deaths, adverse events, costs, and quality- adjusted life years
oProject cost- effectiveness of an updated mRNA booster against COVID -19-associated
illness in persons ages ≥18 years
•Update s to the current version of the model (Phase 3B):
o2-dose strategy (an additional mid- year dose)
o2023- 2024 hospitalization rates (COVID- NET data)
oVaccine dose costs reflect CDC -negotiated 2024- 2025 prices
oAll cost inputs adjusted to 2024$
4* Earlier analyses from this model were presented to ACIP in September 2023, February 2024, and June 2024: Prosser, Lisa A. (2023). Economic Analysis of Vaccination
with mRNA Booster Dose against COVID -19 Among Adults; Prosser, Lisa A (2024). Economic analysis of an additional dose of COVID -19 vaccine; Prosser, Lisa A (2024).
Economic Analysis of COVID -19 Vaccination.
Weekly rates of
COVID -19
associated
hospitalizations
by season, all
ages
52021- 2022
2020- 2021
2019- 2020
2023- 20242022- 2023Hospitalization rate per 100,000
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
40
30
20
10
0Input data for Phase 3b model
Source: COVID -NET
Probability of hospitalization due to COVID -19 illness
Age groups 2023- 2024 2022- 2023 % change
5-11 years 0.000105 0.000133 -21%
12-17 years 0.000139 0.000181 -23%
18-49 years 0.000299 0.000443 -33%
50-64 years 0.001184 0.001551 -24%
>65 years 0.006778 0.007901 -14%
6Source: COVID -NET
Updated seasonality -adjusted vaccine impact*
Health outcomes AgeSeasonality -adjusted vaccine impact
1-dose strategy 2-dose strategy
Base case Low High Base case Low High
•Symptomatic illness (non -
hospitalized)
•Hospitalization,
uncomplicated5-11 y 0.375 0.112 0.705 0.512 0.158 0.716
12-17 y 0.379 0.110 0.704 0.501 0.143 0.711
18-49 y 0.295 0.106 0.442 0.404 0.144 0.482
50-64 y 0.310 0.118 0.453 0.416 0.157 0.492
>65 y 0.315 0.121 0.455 0.422 0.163 0.498
•Critical illness**
•Death5-11 y 0.375 0.112 0.705 0.512 0.158 0.716
12-17 y 0.379 0.110 0.704 0.501 0.143 0.711
18-49 y 0.391 0.221 0.662 0.527 0.355 0.666
50-64 y 0.402 0.234 0.665 0.534 0.366 0.670
>65 y 0.410 0.238 0.665 0.536 0.369 0.671
Source: COVID -NET, VISION, and IVY* Updated hospitalization rates Oct 23 - Sept 24
**Hospitalization requiring ICU and/or ventilator assistance7
Seasonality -adjusted vaccine impact,
2023 -2024 v. 2024 -2025
Age group 1-dose 2-dose
Seasonality -adjusted vaccine impact against symptomatic illness or hospitalization
5-11 years -11% -1%
12-17 years -10% -6%
18-49 years -18% -6%
50-64 years -13% -5%
65+ years -9% -3%
Seasonality -adjusted vaccine impact against critical care (hospitalization with ICU stay or death)
5-11 years -11% -1%
12-17 years -10% -6%
18-49 years -15% -3%
50-64 years -12% -3%
65+ years -9% -2%
8
Vaccine dose cost, 2023 -2024 v. 2024 -2025
92023 2024
%
change CDCPrivate
sector % VFC or
BridgeBase
caseCDC Private
sector% VFC or
BridgeBase
case
5-11 y
Pfizer $65.45 $77.0050% $89.09$65.45 $77.0054% $88.25 -1%Moderna $85.91 $128.00 $85.91 $129.00
12-17 y
Pfizer $97.75 $115.0050% $102.44$99.71 $136.7554% $114.18 10%Moderna $85.91 $128.00 $85.91 $141.80
18+ y
Pfizer $97.75 $115.0012.8% $118.73$99.71 $136.75NA $139.28 15%Moderna $85.91 $128.00 $85.91 $141.80
Source: CDC Vaccine Price List
Additional assumptions: 2 -dose strategy
•Adverse events: Twice the number of the 1 -dose strategy
•Costs of vaccination: Twice the cost of the 1 -dose strategy
•See additional slides
10
Analysis Plan
•Conduct base case and uncertainty analyses (one -way sensitivity and scenario
analyses) comparing no vaccination, 1 -dose, and 2 -dose strategies
•Project disaggregated outcomes stratified by intervention strategy and by age
subgroups (5 -11y, 12- 17y, 18- 49y, 50- 64y, >65y) – supplemental slides
oCases
oHospitalizations
oICU
oLong COVID
oDeaths
oCosts
oQALYs
oAdverse events
***This presentation reports preliminary results from the fourth phase of an ongoing analysis***
11
•Multi -way sensitivity analyses/parameter sets
oVaccination -related costs
oVaccination settings
oHospitalization and critical illness
•Scenario analyses
oSeasonality adjusted vaccine impact
oAlternative seasonality scenarios
oProbability of hospitalization - proxy for lower and higher risk cohorts
oProbability of critical care - proxy for higher risk cohorts
oProbability of symptomatic illness
oVaccine dose cost
•One-way sensitivity analyses
12Analysis Plan cont.: Uncertainty analyses
Results
13
Disaggregated results, per 100,000, societal perspective,
2024 -2025 vaccination, preliminary results
1405,00010,00015,00020,00025,00030,00035,00040,000
5-11 y 12-17 y 18-49 y 50-64 y ≥65 y# Events
0100200300400500600
5-11 y 12-17 y 18-49 y 50-64 y ≥65 y# Long COVID
0100200300400500600700800
5-11 y 12-17 y 18-49 y 50-64 y ≥65 y# Hospitalizations
0102030405060708090100
5-11 y 12-17 y 18-49 y 50-64 y ≥65 y# ICU stays
0510152025303540
5-11 y 12-17 y 18-49 y 50-64 y ≥65 y# Deaths
Note: Height of bars represents total outcomes without vaccination
Disaggregated results, per 100,000, societal perspective, 2024 -2025
vaccination, preliminary results
Age Intervention strategyOutcomes Outcomes Averted
CasesLong
COVIDHosp. ICU Deaths CasesLong
COVIDHosp. ICU Deaths
5-11 yNo vaccination 31,450 70.6 10.5 2.2 0.1 - - - - -
Vaccination, 1 -dose 19,656 44.1 6.6 1.3 0.1 11,794 26.5 3.9 0.8 0.0
Vaccination, 2 -dose 15,348 34.4 5.1 1.1 0.0 4,309 9.7 1.4 0.3 0.0
12-17 yNo vaccination 31,450 71.5 13.9 2.9 0.1 - - - - -
Vaccination, 1 -dose 19,530 44.4 8.6 1.8 0.1 11,919 27.1 5.3 1.1 0.0
Vaccination, 2 -dose 15,694 35.7 6.9 1.4 0.1 3,837 8.7 1.7 0.4 0.0
18-49 yNo vaccination 31,450 413.0 29.9 3.9 0.4 - - - - -
Vaccination, 1 -dose 22,172 299.1 21.1 2.4 0.2 9,278 121.8 8.8 1.5 0.2
Vaccination, 2 -dose 18,744 246.1 17.8 1.8 0.2 3,428 45.0 3.3 0.5 0.1
50-64 yNo vaccination 28,410 395.4 118.0 22.8 3.8 - - - - -
Vaccination, 1 -dose 19,603 272.8 81.4 13.6 2.3 8,807 122.6 36.6 9.2 1.5
Vaccination, 2 -dose 16,591 230.9 68.9 10.6 1.9 3,011 41.9 12.5 3.0 0.5
>65 yNo vaccination 33,390 498.2 678.0 90.9 34.4 - - - - -
Vaccination, 1 -dose 22,872 341.3 464.4 53.6 21.4 10,518 156.9 213.6 37.3 12.9
Vaccination, 2 -dose 19,299 288.0 391.9 42.2 17.3 3,573 53.3 72.6 11.5 4.1
15
Incremental cost -effectiveness ratios (ICERs), per 1000,
societal perspective, 2024 -2025 vaccination, preliminary results
Age group Intervention strategy Projected costsIncremental
costsProjected
QALYsIncremental
QALYsICER
($/QALY)
5-11 yNo vaccination $39,723 - 26,788 - -
Vaccination, 1 -dose $191,776 $152,053 26,789 0.6566 $231,570
Vaccination, 2 -dose $353,283 $161,507 26,789 0.2129 $758,268
12-17 yNo vaccination $46,010 - 24,638 - -
Vaccination, 1 -dose $214 ,115 $168,105 24,639 0.6733 $249,670
Vaccination, 2 -dose $394,045 $179,930 24,639 0.1942 $926,390
18-49 yNo vaccination $128,351 - 20,208 - -
Vaccination, 1 -dose $289,206 $160,855 20,209 0.4802 $335,010
Vaccination, 2 -dose $474,497 $185,290 20,209 0.1633 $1,134,840
50-64 yNo vaccination $218,703 - 12,278 - -
Vaccination, 1 -dose $347,499 $128,796 12,279 0.6197 $207,834
Vaccination, 2 -dose $523,448 $175,949 12,279 0.1957 $898,653
>65 yNo vaccination $336,230 - 6,525 - -
Vaccination, 1 -dose $419,404 $83,174 6,527 1.4132 $58,855
Vaccination, 2 -dose $577,132 $157,729 6,528 0.4424 $356,534
16 ICER = incremental cost effectiveness ratio; QALY = quality- adjusted life year
Incremental cost -effectiveness ratios (ICERs), adding a 2 -dose
strategy, societal perspective, 2024 -2025 vaccination,
preliminary results
Age group Intervention strategy ICER ($/QALY)
5-11 yNo vaccination -
Vaccination, 1 -dose $231,570
Vaccination, 2 -dose $758,268
12-17 yNo vaccination -
Vaccination, 1 -dose $249,670
Vaccination, 2 -dose $926,390
18-49 yNo vaccination -
Vaccination, 1 -dose $335,010
Vaccination, 2 -dose $1,134,840
50-64yNo vaccination -
Vaccination, 1 -dose $207,834
Vaccination, 2 -dose $898,653
>65 yNo vaccination -
Vaccination, 1 -dose $58,855
Vaccination, 2 -dose $356,534
17 QALY = quality -adjusted life year
$0 $50,000 $100,000 $150,000 $200,000 $250,000Productivity loss due to Long COVID (0.25, 1)Cost of nirmatrelvir-r ($0, $1494)Probability of outpatient visit given symptomatic COVID-19 (0.1996, 0.3088)Time spent to receive vaccine, physician office setting (0.17, 2)Lifetime productivity loss ($189191, $378382)(Quality adjustment for symptomatic COVID-19 (0.0018, 0.0074)Probability of symptomatic COVID-19 (0.2312, 0.451)Cost of vaccine dose ($30, $140)Probability of hospitalization (0.00235, 0.0209)SAVI*
$/QALY1-way sensitivity analyses, 1 -dose strategy, >65 y
18Note: Numbers in parenthesis indicate range of input values
* Seasonality adjusted vaccine impact (SAVI) against hospitalization 1 -dose: 0.121, 0.455; SAVI against critical illness 1- dose: 0.238, 0.665
QALY = quality -adjusted life year; ICER = incremental cost effectiveness ratio; SAVI = seasonality -adjusted vaccine impact; CS = cost-saving
CS
CS
Base case: $58,855
1-way sensitivity analyses, 2 -dose strategy, >65 y
19Note: Numbers in parenthesis indicate range of input values
* Seasonality adjusted vaccine impact (SAVI) against hospitalization 2 -dose: 0.163, 0.498; SAVI against critical illness 2- dose: 0.369, 0.671
QALY = quality -adjusted life year; ICER = incremental cost effectiveness ratio; SAVI = seasonality -adjusted vaccine impact
Base case: $356,534 $0 $500,000 $1,000,000 $1,500,000 $2,000,000Probability of death given ICU, no ventilator (0.105, 0.162)Probability of death given ICU with ventilator (0.466, 0.599)Probability of systemic reaction (0.107, 0.171)Quality adjustment for systemic reaction (0.0001, 0.0004)Time spent to receive vaccine, physician office setting (0.17, 2)Probability of symptomatic COVID-19 illness (0.2312, 0.451)Quality adjustment for symptomatic COVID-19 (0.0018, 0.0074)Cost of vaccine dose ($30, $140)Probability of hospitalization given symptomatic COVID-19 (0.00235, 0.0209)SAVI *
$/QALY
ICERs, 1 -way sensitivity analysis, probability of
hospitalization, societal perspective, 2024 -2025 vaccination,
preliminary results
*Probability of hospitalization inputs, base case (range): 5-11 y: 0.000105 (0.0000168 - 0.000336); 12- 17 y: 0.000139 (0.0000252 - 0.000456);
18-49 y: 0.000299 (0.0000799 - 0.00204); 50-64 y: 0.00118 (0.000348 - 0.00479); >65 y 0.00678 (0.00235 - 0.02090)
ICER = incremental cost -effectiveness ratio; QALY = quality- adjusted life yearAge group Intervention strategyICER ($/QALY)
Base case Lower bound Upper bound
5-11 yVaccination, 1 -dose $231,570 $237,799 $216,062
Vaccination, 2 -dose $758,268 $773,808 $719,816
12-17 yVaccination, 1 -dose $249,670 $256,907 $230,464
Vaccination, 2 -dose $926,390 $944,391 $878,879
18-49 yVaccination, 1 -dose $335,010 $363,084 $183,058
Vaccination, 2 -dose $1,134,840 $1,207,451 $746,171
50-64 yVaccination, 1 -dose $207,834 $309,213 $29,782
Vaccination, 2 -dose $898,653 $1,208,636 $373,246
>65 yVaccination, 1 -dose $58,855 $163,421 Cost saving
Vaccination, 2 -dose $356,534 $682,429 $99,455
20
ICER, scenario analysis varying probability of hospitalization,
societal perspective, 2024 -2025 vaccination,
preliminary results
21Age
groupIntervention strategyICER ($/QALY)
¼ base case ½ base case Base case 2x base case 3x base case 4x base case
5-11 yVaccination, 1 -dose $237,123 $235,256 $231,570 $224,381 $217,426 $210,693
Vaccination, 2 -dose $772,119 $767,458 $758,268 $740,400 $723,184 $706,585
12-17 yVaccination, 1 -dose $256,292 $254,067 $249,670 $241,081 $232,755 $224,680
Vaccination, 2 -dose $942,860 $937,321 $926,390 $905,095 $884,525 $864,645
18-49 yVaccination, 1 -dose $363,779 $353,853 $335,010 $300,917 $270,898 $244,263
Vaccination, 2 -dose $1,209,252 $1,183,547 $1,134,840 $1,046,999 $969,960 $901,847
50-64 yVaccination, 1 -dose $317,597 $274,393 $207,834 $121,533 $68,015 $31,582
Vaccination, 2 -dose $1,234,636 $1,101,255 $898,653 $641,036 $484,085 $378,439
>65 yVaccination, 1 -dose $192,897 $127,480 $58,855 $1,483 Cost saving Cost saving
Vaccination, 2 -dose $775,607 $569,600 $356,534 $180,751 $103,912 $60,824
Adjusted risk of hospitalization by underlying condition: hypertension: 2.8, coronary artery disease: 1.3, history of stroke: 0.9, diabetes: 3.2, obesity: 2.9,
severe obesity: 4.4, chronic kidney disease: 4.0, asthma: 1.4, chronic obstructive pulmonary disease: 0.9 . Ko et al 2021.
ICER = incremental cost effectiveness ratio; QALY = quality- adjusted life year
ICER, scenario analysis varying probability of hospitalization*,
age >65, societal perspective, 2024 -2025 vaccination,
preliminary results
22Age
groupIntervention strategyICER ($/QALY)
¼ base case
(169 per
100,000)½ base case
(339 per
100,000)Base case
(678 per
100,000)2x base case
(1356 per
100,000)3x base case
(2033 per
100,000)4x base case
(2711 per
100,000)
>65 yVaccination, 1 -dose $192,897 $127,480 $58,855 $1,483 Cost saving Cost saving
Vaccination, 2 -dose $775,607 $569,600 $356,534 $180,751 $103,912 $60,824
*Adjusted risk of hospitalization by underlying condition: chronic obstructive pulmonary disease: 0.9, history of stroke: 0.9 , coronary artery
disease: 1.3, asthma: 1.4, hypertension: 2.8, obesity: 2.9, diabetes: 3.2, chronic kidney disease: 4.0, severe obesity: 4.4. Ko et al 2021.
ICER = incremental cost -effectiveness ratio; QALY = quality- adjusted life year
ICER, scenario analysis varying probability of critical care,
societal perspective, 2024 -2025 vaccination,
preliminary results
23Age group Intervention strategyICER ($/QALY)
Base case* 2x 3x 4x
5-11 yVaccination, 1 -dose $231,570 $226,638 $221,839 $217,169
Vaccination, 2 -dose $758,268 $744,568 $731,285 $718,401
12-17 yVaccination, 1 -dose $249,670 $245,073 $240,586 $236,205
Vaccination, 2 -dose $926,390 $912,162 $898,312 $884,826
18-49 yVaccination, 1 -dose $335,010 $310,742 $288,947 $269,266
Vaccination, 2 -dose $1,134,840 $1,066,161 $1,004,627 $949,177
50-64 yVaccination, 1 -dose $207,834 $146,192 $105,154 $75,870
Vaccination, 2 -dose $898,653 $692,143 $556,444 $460,466
>65 yVaccination, 1 -dose $58,855 $28,898 $12,731 $2,614
Vaccination, 2 -dose $356,534 $239,110 $175,202 $135,015
*Base case probability of ICU given hospitalization: 5 -11 y - 0.205; 12- 17 y - 0.208; 18- 49 y - 0.130; 50- 64 y - 0.193, >65 y - 0.134
Adjusted risk ratios for ICU: 1 condition: 1.32, 2- 5 conditions: 1.60, 6- 10 conditions: 1.84, >10 conditions: 1.96. Underlying c onditions: Essential hypertension,
Disorders of lipid metabolism, Obesity, Diabetes with complication, Coronary atherosclerosis and other heart disease, Esophag eal disorders, Chronic kidney disease,
Anxiety and fear -related disorders, COPD and bronchiectasis, Thyroid disorders, Depressive disorders, Implant device or graft -related encounter, Sleep -wake
disorders, Neurocognitive disorders, Osteoarthritis, Aplastic anemia, Diabetes without complication, Asthma. Source: Kompaniyets et al 2021.
ICER = incremental cost effectiveness ratio; QALY = quality -adjusted life year
Scenario analysis: vaccination -related costs, societal
perspective, 2024 -2025 vaccination, preliminary results
Age group Intervention strategyICER ($/QALY)
Base case All lower All upper
5-11 yVaccination, 1 -dose $231,570 $103,396 $353,999
Vaccination, 2 -dose $758,268 $363,134 $1,135,689
12-17 yVaccination, 1 -dose $249,670 $92,955 $325,103
Vaccination, 2 -dose $926,390 $383,118 $1,187,889
18-49 yVaccination, 1 -dose $335,010 $71,945 $382,665
Vaccination, 2 -dose $1,134,840 $361,230 $1,274,981
50-64 yVaccination, 1 -dose $207,834 $4,019 $244,737
Vaccination, 2 -dose $898,653 $253,551 $1,015,457
>65 yVaccination, 1 -dose $58,855 Cost saving $75,585
Vaccination, 2 -dose $356,534 $70,458 $409,976
ICER = incremental cost effectiveness ratio; QALY = quality- adjusted life year
ICER, scenario analyses varying vaccination costs,
age >65, societal perspective, 2024 -2025 vaccination,
preliminary results
Age
groupIntervention strategyICER ($/QALY)
$20 $60 $80 $100Base case
$133
>65 yVaccination, 1 -dose Cost saving $2,755 $16,908 $31,060 $58,855
Vaccination, 2 -dose $86,910 $177,327 $222,536 $267,744 $356,534Age group Intervention strategyICER ($/QALY)
All lower Base case All upper
>65 yVaccination, 1 -dose Cost saving $58,855 $75,585
Vaccination, 2 -dose $70,458 $356,534 $409,976
Varying vaccine dose cost onlyVarying all vaccination -related costs*
25*Multi -way sensitivity analysis varying vaccine dose cost, vaccine administration cost, time costs of vaccination, and cost of
vaccine -associated adverse events to lower and upper bounds. See supplementary slide 44 for input data.
ICER = i ncremental cost-effectiveness ratio; QALY = quality- adjusted life year
Scenario analysis: vaccine dose cost, 2024 -2025
vaccination, preliminary results
$0$200,000$400,000$600,000$800,000$1,000,000$1,200,000
$20 $30 $40 $50 $60 $70 $80 $90 $100 $110 $120 $130 $140$114$88
$0$200,000$400,000$600,000$800,000$1,000,000$1,200,000
$20 $30 $40 $50 $60 $70 $80 $90 $100 $110 $120 $130 $140$114$881-dose 2-dose
$139
Cost per dose Cost per dose$/QALY
$/QALY
Note: arrows indicate base case vaccine dose cost by age group
QALY= quality -adjusted life year$139$139$139
$139
$139
Limitations
•Unpublished data used to derive key parameters in the model: vaccine effectiveness,
symptomatic illness, probabilities of hospitalization and critical illness
•Data sources vary in representativeness, generalizability
•VE estimates derived from single prior season data
•Few seasons to date to estimate seasonality
•MarketScan data for ages >65 only includes those with supplemental insurance
•Evidence base for long covid is especially scarce
•Model does not include reduced transmission (conservative approach)
27
Summary
2024- 2025 COVID -19 vaccination, 2 -dose strategy
•ICERs for age groups <65 y were less favorable than for those > 65 y across
plausible parameter ranges
•For >65 years, ICERs are sensitive to seasonality -adjusted vaccine impact,
probability of hospitalization, and costs of vaccination
•ICERs are more favorable in scenarios with higher risk of hospitalization and
lower costs of vaccination
28