Document text
Economic Analysis of Vaccination
with mRNA Booster Dose
against COVID -19 Among Adults
University of Michigan
COVID -19 Vaccination Modeling Team
Presentation to ACIP
September 12, 2023
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, PhD
Additional contributors to 2021 Covid Vaccination Model:
Marisa Eisenberg, Emily Martin, Grace Chung, Janamarie
Perroud, Ellen Kim Deluca, Chris Cadham, Huey -Fen Chen,
Anton L.V. Avancena, Tran Doan, David SuhCenters 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
•Estimate 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
•Project cost -effectiveness of an updated mRNA booster against COVID -19-
associated illness in persons ages ≥18 years
4
Methods
•Intervention strategies:
oVaccination against COVID -19 illness with an updated “generic” mRNA booster
oNo updated mRNA booster (vaccination against COVID -19 illness with primary series only or
primary series plus current booster)
•Target population: all US adults, stratified by age
o18-49 y, 50 -64 y, 65+ y
oPediatric and adolescent age groups excluded from current analysis, insufficient data to
incorporate into this first phase analysis
•Time horizon: 1 year*
•Perspective: Societal
•Costing year: 2023$
•Discount rate: 3%
* Costs and QALYs lost due to long -term sequelae and deaths beyond one year are included
5
VaccinationSymptomatic
COVID -19
(non -hospitalized)
Hospitalized
COVID -19Non -medically
attended*
Outpatient visit
No ICU
admission
ICU admissionNo side
effects
Systemic
reaction
Anaphylaxis
Severe
adverse eventA
A
A
ANo booster
AB
No
complications
Long Covid
No ventilator
VentilatorB
CDeathModel schematic
No
COVID -19
COVID -19No long Covid
Long Covid
Long -term
sequelae C
No
complications
Long Covid
Death
6ED visit B
*Includes probability and costs of testing
ED= emergency department; ICU= intensive care unit
Analysis Plan
•Project health and economic outcomes stratified by intervention strategy and by
age subgroups (18 -49y, 50 -64y, 65+y)
oCases
oHospitalizations
oDeaths
oCosts
oQALYs
oAdverse events
•Calculate incremental cost -effectiveness ratios comparing updated mRNA booster
to no booster
•Conduct base case and uncertainty analyses (one -way sensitivity and scenario
analyses)
***This presentation reports preliminary results from the first phase of an ongoing
analysis***
7
Natural history:
probability of symptomatic infection, outpatient/ED
visits, hospitalization, and critical illness
8
Annual probability of symptomatic infection
9Overall
02000040000
12345678910111212345678910111212345
2021 2022 2023Rate/100,000/month
18-49y 50-64y 65+yLast 6 months
Source: HEROES -RECOVER, unpublished dataAnnualized probability
based on last 6 months
12/22 -5/23
18-49 y 0.3145
50-64 y 0.2841
65+ y 0.3339
Annual probability of symptomatic infection
10Annualized probability based on last 6 months
12/22 -5/23
Age group Base caseRange for sensitivity analysis
Low High
18-49 y 0.3145 0.2858 0.3444
50-64 y 0.2841 0.2438 0.3274
65+ y 0.3339 0.2312 0.4510
Source: HEROES -RECOVER, unpublished data
05001,0001,5002,0002,5003,000
10
202011 12 1
20212 3 4 5 6 7 8 9 10 11 12 1 2
20223 4 5 6 7 8 9 10Visits/100,000 Enrollees/month
18 - 49 Years 50 - 64 Years 65+ YearsProbability of an outpatient visit
11Annualized Probability based on last 6 months
5/22 -10/22
Age
groupBaseRange for sensitivity
analysis
Low High
18-49 y 0.075 0.022 0.110
50-64 y 0.106 0.041 0.159
65+ y 0.111 0.040 0.150Last 6 months
Source: Merative™MarketScan® Research Database, unpublished data
Probability of outpatient visits and ED visits given
symptomatic illness
12Age group BaseRange for sensitivity analysis
Low High
Outpatient visits given symptomatic illness
18 -49 y 0.157 0.1483 0.1664
50 -64 y 0.215 0.1991 0.2335
65+ y 0.244 0.1996 0.3088
Emergency department visits given symptomatic illness
18 -49 y 0.0184 0.0172 0.0196
50 -64 y 0.0191 0.0175 0.0210
65+ y 0.0394 0.0318 0.0505
Source: Derived using probability of an outpatient visit or ED visit from MarketScan data ( Merative™MarketScan® Research
Database, unpublished data) and probability of symptomatic illness in the HEROES -RECOVER data, May 2022 -October 2022
(unpublished)
050100150200250300350400
91011121234567891011121234567891011121234
2020 2021 2022 2023Rate/100,000/month
18-49 years 50-64 years 65+ yearsAnnual probability of hospitalization
13Annualized Probability based on last 6 months
10/22 -3/23
Age group Base caseRange
Low High
18-49 y 0.00144 0.00080 0.00204
50-64 y 0.00335 0.00216 0.00479
65+ y 0.01453 0.00967 0.02090Last 6 months
Source: COVID -NET, unpublished dataRate/100,000 based on last 6 months
10/22 -3/23
Age groupBase case
per 100,000Range
Low High
18-49 y 144 80 204
50-64 y 335 216 479
65+ y 1453 967 2090
Probability of critical illness given hospitalization
14Probability Base caseRange for sensitivity analysis (95% CI)
Low High
Probability ICU given hospitalization
18-49 y 0.123 0.119 0.145
50-64 y 0.200 0.178 0.208
65+ y 0.144 0.138 0.163
Probability ventilator use given ICU
18-49 y 0.525 0.472 0.577
50-64 y 0.488 0.445 0.532
65+ y 0.386 0.342 0.432
Source: COVID -NET, unpublished data
ICU= intensive care unit
Probability of death given hospitalization
15Source: COVID -NET, unpublished data
ICU= intensive care unitProbability Base caseRange (95% CI)
Low High
Probability of death given no ICU
18-49 y 0.006 0.002 0.008
50-64 y 0.009 0.007 0.016
65+ y 0.030 0.022 0.035
Probability of death given ICU without ventilator
18-49 y 0.024 0.003 0.040
50-64 y 0.047 0.026 0.077
65+ y 0.166 0.144 0.233
Probability of death given ICU with ventilator
18-49 y 0.284 0.213 0.368
50-64 y 0.379 0.301 0.435
65+ y 0.628 0.476 0.637
Probability of long COVID
16Age group Base caseRange
Low High
18-49 y 0.072 0.058 0.091
50-64 y 0.072 0.058 0.091
65+ y 0.072 0.058 0.091
Source: Montoy JCC et al. Prevalence of Symptoms ≤12 Months After Acute Illness, by COVID -19 Testing Status Among Adults —Unite d States, December 2020 –
March 2023. MMWR 2023; 72 (32): 859 -865.Assumptions :
•Derived to reflect 5 -month median duration of episode of long covid for individuals who experience
symptoms for 3+ months
•Average prevalence of HEENT, constitutional, pulmonary, musculoskeletal, cognitive, and fatigue symptoms
at 5 months
•Current estimates do not reflect higher risk associated with age or with severity of illness
Vaccine effectiveness & adverse events
17
Vaccine effectiveness: hospitalization, 18+ y
1862%
47%
24%57%
41%
12%67%
53%
33%
0%20%40%60%80%100%
0 73 146 219 292 365Vaccine Efficacy Against Hospitalization (%) Interval Days since Last Dose (days)VISION(Sep 2022 -May 2023)
62%
47%
24%
0%20%40%60%80%100%
0 73 146 219 292 365Vaccine Efficacy Against Hospitalization (%)
Interval Days since Last Dose (days)VISION (Sep 2022 -May 2023)
Source: VISION, bivalent booster, Sept 2022 -May 2023 . Link -Gelles R. Monovalent and bivalent VE against hospitalization among adults aged
≥18 years. Paper presented at: Advisory Committee on Immunization Practices. June 2023Conservative scenarioOptimistic scenario
Vaccine effectiveness: hospitalization, 18+ y
1954%
34%
6%39%
15%65%
50%
30%
0%20%40%60%80%100%
0 73 146 219 292 365Vaccine Efficacy against Hospitalization (%)
Interval Time since Last Dose (days)IVY (Sep 2022 -May 2023)
54%
34%
6%
0%20%40%60%80%100%
0 73 146 219 292 365Vaccine Efficacy against Hospitalization (%)
Interval Time since Last Dose (days)IVY (Sep 2022 -May 2023)
Source: IVY , bivalent booster, Sept 2022 -May 2023. Link-Gelles R. Monovalent and bivalent VE against hospitalization among adults aged
≥18 years. Paper presented at: Advisory Committee on Immunization Practices. June 2023Conservative scenarioOptimistic scenario
Vaccine effectiveness: hospitalization, 18+ y
20Source: VISION and IVY, bivalent vaccination,
Sept 2022 -May 2023 . Link -Gelles R. Monovalent
and bivalent VE against hospitalization among
adults aged ≥18 years. Paper presented at:
Advisory Committee on Immunization Practices.
June 2023Area under the curve: 0.2690%20%40%60%80%100%
0 73 146 219 292 365Vaccine Efficacy Against Hospitalization (%)
Interval Days since Last Dose (days)Lower boundUpper boundVISION (Sep 2022 -May 2023)
0%20%40%60%80%100%
0 73 146 219 292 365Vaccine Efficacy Against Hospitalization (%)
Interval Days since Last Dose (days)Lower boundUpper boundIVY (Sep 2022 -May 2023)
61%
46%
22%
0%20%40%60%80%100%
0 73 146 219 292 365Vaccine Efficacy Against Hospitalization (%)
Interval Days since Last Dose (days)Combined -VISION and IVY (Sep 2022 -May 2023)
Vaccine effectiveness, hospitalization, 18+ y
21Linear waning Conservative Optimistic
VISION
Base case 0.278 0.217 0.339
Lower bound 0.210 0.180 0.240
Upper bound 0.334 0.250 0.418
IVY
Base case 0.168 0.153 0.183
Lower bound 0.088 0.088 0.088
Upper bound 0.313 0.237 0.389
Base Case* 0.269 0.088 0.418
* Base case includes a weighted average of the area under the vaccine effectiveness (VE) curve with the assumption that VE wane s linearly after 180 days. Range s were
selected by taking the minimum and maximum of the individual dataset VEs, applying a conservative approach (assuming VE drops to0 at 180 days) for the lower bound
and an optimistic approach for the upper bound (assuming VE at 365 days=VE at 180 days)
Summary, vaccine effectiveness
22Base case Low High
Symptomatic illness (non -hospitalized)*
Hospitalization, uncomplicated 0.269 0.088 0.418
Hospitalization, critical illness** 0.403 0.191 0.671
Death 0.403 0.191 0.671
Source: VISION and IVY , Link-Gelles R. Monovalent and bivalent VE against hospitalization among adults aged ≥18 years. Paper
presented at: Advisory Committee on Immunization Practices. June 2023* Non -medically attended illness, illness that includes an outpatient or ED visit
** Intensive care unit with or without mechanical ventilation
Summary, vaccine effectiveness
23Base case Low High
Symptomatic illness (non -hospitalized)* 0.269 0.088 0.418
Hospitalization, uncomplicated 0.269 0.088 0.418
Hospitalization, critical illness** 0.403 0.191 0.671
Death 0.403 0.191 0.671
Source: VISION and IVY , Link-Gelles R. Monovalent and bivalent VE against hospitalization among adults aged ≥18 years. Paper
presented at: Advisory Committee on Immunization Practices. June 2023* Non -medically attended illness, illness that includes an outpatient or ED visit
** Intensive care unit with or without mechanical ventilation
Probability of adverse events
24Base caseRange for sensitivity analysis
Source
Low High
Systemic reaction
18-49 y 0.106 0.073 0.148
1,2 50-64 y 0.106 0.073 0.148
≥65 y 0.137 0.107 0.171
Anaphylaxis (all ages) 0.00000495 0.0000032 0.0000074 3
Death given anaphylaxis 0 0 0.00966 Assumption, 4
Myocarditis
18 -29 y 0.0000238 0.0000085 0.0000838 5
30-39 y 0.0000087 0.0000008 0.0000375 5
40+ y 0 0 0 Assumption
Death given myocarditis 0.0005 0 0.001 Expert opinion
1. U.S. Food and Drug Administration. Fact Sheet for Healthcare Providers Administering Vaccine: Emergency Use Authorization of Moderna COVID -19 Vaccine, Bivalent (Original
and Omicron BA.4/BA.5). In: U.S. Department of Health and Human Services, ed2023.
2. U.S. Food and Drug Administration. Fact Sheet for Healthcare Providers Administering Vaccine: Emergency Use Authorization o f Pfizer -Biontech COVID -19 Vaccine, Bivalent
(Original and Omicron BA.4/BA.5). In: U.S. Department of Health and Human Services, ed2023.
3. Klein NP, Lewis N, Goddard K, et al. Surveillance for Adverse Events After COVID -19 mRNA Vaccination. JAMA. 2021;326(14):1390 -1399.
4.Su JR, Moro PL, Ng CS, Lewis PW, Said MA, Cano MV. Anaphylaxis after vaccination reported to the Vaccine Adverse Event Repor ting System, 1990 -2016. J Allergy Clin Immunol.
2019;143(4):1465 -1473.
5. Kristin Goddard KEH, Ned Lewis,. Incidence of Myocarditis/Pericarditis Following mRNA COVID -19 Vaccination Among Children and Yo unger Adults in the United States. Annals of
Internal Medicine. 2022;175(12):1169 -1771.
Costs: Direct medical costs and productivity losses
25
Direct medical costs
Variable Base caseRange for sensitivity analysis
Source
Low High
Testing
Test cost $8 $8 $62 1,2
Probability of testing 0.05 0.02 0.20 3
Recipient time (hours) 0.50 0.25 1.50 Assumption
Outpatient visit
18-49 y $372 $370 $375
4 50-64 y $380 $377 $384
65+ y $391 $386 $396
Long Covid $1091 $1018 $1165 5
261. Justin Lo CC, Krutika Amin, Imani Telesford, Lindsey Dawson, and Jennifer Kates. Prices for COVID -19 testing. 2023; https://www.healthsystemtracker.org/brief/prices -for-covid -19-
testing/#Prices%20for%20COVID -19%20tests%20in%20the%20outpatient%20setting,%20among%20people%20with%20large%20employer%20health% 20coverage,%202021 .
2. Walmart. COVID -19 Test Kits. https://www.walmart.com/browse/home -diagnostic -tests/covid -19-test-kits/976760_1005860_542089_3092061 . Accessed September 1, 2023.
3. Rader B GA, Iuliano AD,. Use of At -Home COVID -19 Tests —United States, August 23, 2021 –March 12, 2022
4. Merative™MarketScan® Research Database, unpublished data
5. Pike J et al. Direct Medical Costs Associated With Post –COVID -19 Conditions Among Privately Insured Children and Adults. Prev Ch ronic Dis. 2023;20 (6)
Direct medical costs, cont.
Variable Base caseRange for Sensitivity Analysis
Low High
Hospitalization episode
18-49 y$32,514 $28,505 $36,523
50-64 y$32,854 $31,450 $34,258
65+ y$20,648 $20,295 $21,000
ICU episode (no ventilator)
18-49 y $37,159 $30,116 $44,203
50-64 y $46,727 $40,269 $53,186
65+ y $23,220 $22,408 $24,032
ICU (with ventilator) episode
18-49 y $245,432 $168,362 $322,503
50-64 y $169,189 $140,250 $198,129
65+ y $55,257 $50,705 $59,809
27ICU= Intensive care unitSource: Merative ™MarketScan® Research Database, unpublished data
Medication costs
Variable Base caseRange for Sensitivity Analysis
Source
Low High
Over the counter medication* $4.12 - - 1
Probability of nirmatrelvir -r prescription
given an outpatient visit
18-49 years 0.1751 0.10 0.30
2,3, Assumption 50-64 years 0.2696 0.10 0.50
65+ years 0.2739 0.10 0.50
Cost, nirmatrelvir -r $530 $530 $1200 4, 5
28*5 days of generic cold/flu medicine
1. Target.com Accessed August 29, 2023.
2. HealthVerity, Inc. COVID -19 database licensed by CDC, unpublished data
3. Merative™MarketScan® Research Database, unpublished data
4. Recht H. Paxlovid Has Been Free So Far. Next Year, Sticker Shock Awaits. 2022; https://kffhealthnews.org/news/article/paxlovid -covid -sticker -shock -
insurance/#:~:text=The%20U.S.%20government%20has%20so,in%20a%20July%20earnings%20call .
5. Murez C. Paxloid soon won’t be free for Americans. 2022 https://www.usnews.com/news/health -news/articles/2022 -12-07/paxlovid -soon -wont -be-free-for-americans . Accessed September 7, 2023
Vaccine receipt, costs
Variable Base caseRange for Sensitivity Analysis
Source
Low High
mRNA monovalent booster, per dose* $120 $30 $200 1, expert opinion
Administration, per dose** $20.33 $18.07 $26.58 2
Vaccination setting
Proportion, pharmacy 0.644 0.625 0.663 3
Proportion, physician office visit 0.256 0.221 0.294 3
Proportion, mass vaccination 0.100 0.075 0.155 3
Recipient time by vaccination setting (hours)
Pharmacy 0.25 0.083 0.50 4, expert opinion
Physician office 1.19 0.17 2 4
Mass vaccination 0.195 0 0.390 4
Mean hourly earnings $33.74 $23.98 $50.16 5
29*Lower bound reflects current price of COVID -19 boosters
**CPT 90471
1. Kates J et al. How much could COVID -19 vaccines cost the US after commercialization? 2023. https://www.kff.org/coronavirus -covid-19/issue -brief/how -much -could -covid -19-vaccines -cost-the-u-s-after -
commercialization/
2. Centers for Medicare & Medicaid Service. Search the Physician Fee Schedule. 2023; https://www.cms.gov/medicare/physician -fee-schedule/search?Y=0&T=0&HT=0&CT=3&H1=90471&M=5
3. CDC national survey data, 2/10/23 -5/1/23, unpublished
4. Prosser L, O'Brien M, Molinari N, et al. Non -traditional settings for influenza vaccination of adults: Costs and cost -effectiv eness. Pharmacoeconomics. 2008;26(2):163 -178.
5.US Bureau of Labor Statistics. Average hourly and weekly earnings of all employees on private nonfarm payrolls by industry se ctor, seasonally adjusted. 2023; https://www.bls.gov/news.release/empsit.t19.htm
Vaccination -associated adverse events, costs
Variable Base caseRange for Sensitivity AnalysisSource
Low High
Systemic reaction
Physician visit $90.82 $82.72 $115.84 1
Productivity loss (days) 1 - - Assumption
Anaphylaxis
Hospitalization $5035 2*
Productivity loss (days) 1 1 3 3
Myocarditis/pericarditis
Hospitalization $75,927 4**
Productivity loss (days) 4 0 14 5, 6, Expert opinion
30* HCUP -NIS 2012 estimates (mean LOS = 4.9 days) adjusted to 1 days LOS
** HCUP -NIS 2014 estimates (mean LOS = 7.4 days) adjusted to 4 days LOS
1. Centers for Medicare & Medicaid Service. Search the Physician Fee Schedule. 2023; https://www.cms.gov/medicare/physician -fee-schedule/search?Y=0&T=0&HT=0&CT=3&H1=90471&M=5
2. Candrilli S, Kurosky SK. Recent Trends In Anaphylaxis -Related Hospitalization In The United States. Value in Health. 2015;18(7):A503.
3. Shimabukuro T, Cole M, Su JR. Reports of Anaphylaxis After Receipt of mRNA COVID -19 Vaccines in the US -December 14, 2020 -Januar y 18, 2021. Jama. 2021;325(11):1101 -1102.
4. Khorolsky C, Shi J, Chkhikvadze T. Trends In Hospitalization Costs, Length Of Stay And Complications Among Patients With Acut e Myocarditis: A 10 -Year United States Perspective. Journal of the American College
of Cardiology. 2019;73(9_Supplement_1):935 -935.
5. Marshall M, Ferguson I, Lewis P, et al. Symptomatic Acute Myocarditis in Seven Adolescents Following Pfizer -BioNTech COVID -19 Va ccination. Pediatrics. 2021.
6. Shimabukuro T. COVID -19 Vaccine Safety Updates. In. Advisory Committee on Immunization Practices (ACIP)2021.
Quality adjustments
31
QALY losses, COVID -19 illness
32Variable Base CaseRange for Sensitivity Analysis
QALDs lostLow High
Symptomatic illness* 0.006 0.004 0.008 2.2 (1.5 -2.9)
Hospitalization 0.027 - - 9.9
Critical illness** 0.054 - - 19.7
Long COVID 0.067 0.038 0.088 24.3 (13.7 -31.9)
* Non -medically attended and outpatient illness
** Intensive care unit with mechanical ventilation. Derived by applying the ratio of ICU to hospitalization QALY loss (2x) to the
hospitalization QALY loss from SARS CoV -2 EQ5D Study. The model also includes a health state for ICU care without ventilator use for
which QALY loss is interpolated using QALY loss for hospitalization and critical illnessDRAFT
Source: Coronavirus Household Evaluation and Respiratory Testing (C -HEaRT) and Prospective Assessment of COIVD -19 in a Community (PACC), unpublished data
QALY loss, vaccination -associated AEs
33Variable Base CaseRange for Sensitivity Analysis
QALDs lost Source
Low High
Systemic reaction (QALY loss)*
All ages 0.0004 0.0003 0.0005 0.15 (0.11 -0.18) Assumption
Anaphylaxis (QALY loss)
All ages 0.0137 0.0135 0.0139 5.0 (0.93 -5.08) 1
Myocarditis/pericarditis (QALY loss)
Acute illness** 0.010 0.0086 0.0112 3.65 (3.14 -4.09) 2
* QALY loss equal to one day of COVID -19 illness
** Derived from health utility for COVID -19 related myocarditis. Assumed 2 -week illness
QALY= Quality -adjusted life year; QALD= Quality -adjusted life day
1. Prosser LA, Payne K, Rusinak D, Shi P, Uyeki TM, Messonnier ML. Valuing health across the lifespan: health state preferences forseasonal influenza illnesses in patients of different ages. Value in
Health. 2011;14(1):135 -143.
2. Morrow AJ, Sykes R, McIntosh A, et al. A multisystem, cardio -renal investigation of post -COVID -19 illness. Nature Medicine. 2022;28(6):1303 -1313
Results
preliminary estimates
34
Disaggregated results, per 100,000
preliminary estimates
Age
groupStrategyCases Cases Averted
Cases Hosp ICU Deaths Cases Hosp ICU Deaths
18-49 y No booster 31,450 144 17.7 3.6 - - - -
Booster dose 22,990 105 10.6 2.2 8,460 39 7.1 1.4
50-64y No booster 28,410 335 67.1 16.4 - - - -
Booster dose 20,768 245 40.0 9.9 7,642 90 27.0 6.6
65+ yNo booster 33,390 1,453 209.3 109.4 - - - -
Booster dose 24,408 1,062 124.9 66.0 8,982 391 84.3 43.4
35
Incremental cost -effectiveness ratios,
societal perspective, per 1000
preliminary estimates
Age group StrategyProjected
CostsIncremental
CostsProjected
QALYsIncremental
QALYs$/QALY
18-49 y No booster $192,335 - 20207.0670 - -
Booster vaccination $293,503 $101,168 20207.9423 0.8752 $115,588
50-64y No booster $385,752 - 12275.8345 - -
Booster vaccination $421,249 $35,498 12277.2111 1.3766 $25,787
65+ y No booster $642,488 - 6519.9466 - -
Booster vaccination $598,857 -$43,630 6523.5511 3.6046 Cost -saving
36QALY= quality -adjusted life year
Incremental cost -effectiveness ratios,
societal perspective, per 1000
preliminary estimates, w/pooled 18+
Age groupBooster Dose,
$/QALY
18-49 y$115,588
50-64 y$25,787
65+ yCost -saving
18+ y$33,437
37QALY= quality -adjusted life year
One way sensitivity analyses, 18 -49 y
preliminary estimates
38Base case: $115,588 *Non -hospitalized cases
Note: Numbers next to bars indicate input values for sensitivity analysis
VE=vaccine effectiveness; QALY=Quality -adjusted life year$0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000Probability, symptomatic COVID-19Time (h), vaccination, doctor's officeLifetime productivity costVE, hospitalizationProbability, death given ICU with ventilatorQALYs lost symptomatic COVIDProbability, hospitalizationVE, critical illnessVE, symptomatic COVID-19Cost, vaccine
$/QALY$30 $200
0.418 0.088
0.671 0.191
0.002 0.0008
0.008 0.004
0.368 0.213
0.418 0.088
$2,382,347
0.17 2
0.344 0.286*
VE scenario analyses
preliminary estimates
Base case Scenario 1 Scenario 2 Scenario 4 Scenario 5
VE inputs
Symptomatic illness 0.269 0.088 0.418 0.269 0.403
Hospitalization, uncomplicated 0.269 0.088 0.418 0.269 0.403
Hospitalization, critical illness 0.403 0.191 0.671 0.269 0.403
Death 0.403 0.191 0.671 0.269 0.403
$/QALY
18-49 y $115,588 $435,886 $45,376 $141,155 $70,928
50-64 y $25,787 $199,830 Cost -saving $51,792 $3,001
65+ y Cost -saving $51,782 Cost -saving Cost -saving Cost -saving
39VE= vaccine effectiveness; QALY= quality -adjusted life year
Scenario analyses:
probability of symptomatic illness, non -hospitalized*
preliminary estimates
40Age group Base case 0.1 0.2 0.3 0.4 0.5
18-49 y $115,588 $229,724 $160,000 $120,013 $94,082 $75,905
50-64 y $25,787 $48,937 $34,724 $24,324 $16,384 $10,123
65+ y Cost -saving Cost -saving Cost -saving Cost -saving Cost -saving Cost -saving
QALY=Quality -adjusted life year
*One -way sensitivity analysis of non -hospitalized symptomatic illness varied separately from hospitalization and critical illnes s;
base case probability of symptomatic illness: 18 -49 y, 0.3145; 50-64 y, 0.2841; 65+ y, 0.3339
Scenario analysis:
probability of hospitalization
preliminary estimates
41Age group Base case* 2x base case 3x base case 4x base case
18-49 y $115,588 $51,978 $14,541 Cost -saving
50-64 y $25,787 Cost -saving Cost -saving Cost -saving
65+ y Cost -saving Cost -saving Cost -saving Cost -saving
QALY=Quality -adjusted life year
*Base case probability of h ospitalization 18-49 y-0.00144; 50 -64 y-0.00335; 65+ -0.01453
Scenario analysis: probability of critical care
preliminary estimates
42Age groupProbability of ICU given hospitalization
Base case* 2x 3x 4x
18-49 y $115,588 $71,487 $42,307 $21,570
50-64 y $25,787 Cost -saving Cost -saving Cost -saving
65+ y Cost -saving Cost -saving Cost -saving Cost -saving
QALY=Quality -adjusted life year; ICU= Intensive care unit
*Base case probability of ICU given hospitalization: 18 -49 y-0.123; 50 -64 y-0.200, 65+ y -0.144
Scenario analysis: vaccine setting
preliminary estimates
43Age group Base case*100%
pharmacy100%
physician office100%
mass vaccination
18-49 y $115,588 $106,523 $142,759 $104,403
50-64 y $25,787 $20,024 $43,063 $18,676
65+ y Cost -saving Cost -saving Cost -saving Cost -saving
QALY=Quality -adjusted life year
*Base case : Physician office visit -0.256, Pharmacy -0.644, Mass vaccination -0.100
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 data on bivalent booster
▪Hospitalization rates may overestimate cases due to COVID -19 for younger age groups
▪MarketScan data for ages 65+ only includes those with supplemental insurance
▪Evidence base for long covid is especially scarce –future analyses will incorporate adjustments
to reflect differences in probability and duration of long covid by age and severity of illness
▪Cost estimates for long covid may not reflect current practice patterns or rates of HC utilization
44
Summary -preliminary estimates
•Vaccination averts substantial morbidity and mortality as
demonstrated through estimated disaggregated outcomes
•ICERs for 50 -64y and 65+ age groups are robust to changes in
parameter inputs across plausible ranges in all but one scenario
(<$51,800 or cost -saving)
•ICERs for 18 -49y are sensitive to changes in parameter inputs; more
favorable for higher VE, higher risk of hospitalization and critical
illness
45