Document text
Economic Analysis of
COVID -19 Vaccination
University of Michigan
COVID -19 Vaccination Modeling Team
Presentation to the Advisory Committee on Immunization Practices
September 19, 2025
1
Study team
•University of Michigan
•Wake Forest University
•Centers for Disease Control and Prevention
2Conflict of interest statement
No known conflicts of interest.
Economic Analysis of COVID -19 Vaccination: Objectives
Using an economic model of COVID -19 vaccination:
•Estimate the annual population burden of disease in a cohort representing the US
population
oresource utilization (outpatient visits, hospitalizations )
ototal cases
ototal costs
odeaths
oquality -adjusted life years lost due to COVID -19
•Estimate events averted by COVID -19 vaccination
•Estimate incremental cost -effectiveness ratios for subgroups defined by age and risk
status
3Earlier analyses from this model were presented to ACIP in September 2023, February 2024, June 2024, and October 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; Prosser, Lisa A. (2024). Economic analysis of an additional dose of t he 2024 -2025 COVID -19 vaccine.
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 and risk status
o18-49 y, 50 -64 y, ≥65 y
oHigh risk or not at high risk for complications
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: 2024$
•Discount rate: 3%
*Costs and QALYs lost due to long -term sequelae and deaths beyond one year are included 4
Symptomatic
COVID -19
(non -hospitalized)
Hospitalized
COVID -19Non -medically
attended
Outpatient visit
No ICU
admission
ICU admissionAB
No
complications
Long COVID
No ventilator
VentilatorB
DDeathModel
schematic
No
COVID -19
COVID -19No long COVID
Long COVID
Long -term
sequelae C
No
complications
Long COVID
Death
5ED visit B
ED = emergency department; ICU = intensive care unit
Prosser et al. Cost -effectiveness of 2023 -2024 COVID -19 vaccination in US adults. JAMA Network Open. 2025 Aug 1;8(8):e2523688.No ventilator
Ventilator C
D
Updated COVID -
19 vaccinationNo side
effects
Systemic
reaction
Anaphylaxis
Severe
adverse eventA
A
ANo updated
COVID -19
vaccination
A
Epidemiological inputs
6Input Source
Probability of symptomatic illness HEROES -RECOVER
(2022 – 2023)
Probability of medically attended illness MarketScan
(2022)
Probability of hospitalization COVID -NET (2023 - 2024),
expert opinion
Probability of ICU stay and ventilator use COVID -NET
(2022 – 2023)
Probability of death COVID -NET
(2022 – 2023)
Probability of long -term sequalae Published literature
Probability of long COVID Published literature
020406080100120140
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug SepMonthly hospitalizations per 100,000Weekly rates of
COVID -19–
associated
hospitalizations
by season, all
ages
72021 -2022
2020 -2021
2019 -20202022 -2023
2024 -2025
Source: COVID -NETBase case (2023 -2024)
Vaccination -related parameter inputs
8Input Source
Seasonality -adjusted vaccine impact (SAVI) VISION (2024 – 2025),
IVY (2024 – 2025),
COVID -NET (2023 – 2024),
expert opinion
Probabilities of adverse events
•Systemic reaction
•Anaphylaxis
•Myocarditis/pericarditisFDA product approval
information, published
literature, expert opinion
Costs
9Input Source
Illness -related
Direct medical costs
•Outpatient visits
•ED visits
•Hospitalizations
•Long -term sequalae
•Long COVIDMarketScan 2022 -2023,
published literature
Productivity lossesBLS, published literature, expert
opinion
Vaccination -related
Direct medical costs:
•Vaccine dose
•Administration
•Adverse eventsCDC vaccine price list
Physician fee schedule
Published literature, expert opinion
Time costs of vaccination Published literature
BLS = Bureau of Labor Statistics
Quality of life adjustments
10Input Source
Illness -related
•Symptomatic illness
•Hospitalization
•Long -term sequalae
•Long COVIDPublished literature
Vaccination -related
•Systemic reaction
•Anaphylaxis
•Myocarditis/pericarditisPublished literature
Methods: Analysis Plan
•Project health and economic outcomes stratified by intervention strategy, age (18-
49 y, 50 -64 y, ≥65 y) and risk subgroups (high risk, non -high risk)
oCases
oHospitalizations
oDeaths
oCosts
oQuality -Adjusted Life -Years (QALYs)
oAdverse events
oNumber needed to vaccinate (NNV)
11
Methods: Analysis Plan
•Incremental cost -effectiveness ratio (ICER):
CostsUpdated Vaccination – CostsNo Updated Vaccination
QALYsUpdated Vaccination – QALYsNo Updated Vaccination
•Base case analysis
•Sensitivity analyses
•Probabilistic sensitivity analysis
•Univariate and multi -way sensitivity analyses
•Scenario analyses
1212
Results*
13*This presentation reports preliminary results of an ongoing analysis
Disaggregated results, per 100,000 simulated cohort,
societal perspective, 2025 -2026 vaccination
140500010000150002000025000300003500040000
18-49 NHR 50-64 NHR >65 NHR 18-49 HR 50-64 HR >65 HRCases
020040060080010001200
18-49 NHR 50-64 NHR >65 NHR 18-49 HR 50-64 HR >65 HRHospitalizations
020406080100120140160
18-49 NHR 50-64 NHR >65 NHR 18-49 HR 50-64 HR >65 HRICU Stays
0102030405060
18-49 NHR 50-64 NHR >65 NHR 18-49 HR 50-64 HR >65 HRDeaths - 100 200 300 400 500 600
18-49 NHR 50-64 NHR >65 NHR 18-49 HR 50-64 HR >65 HRCases of Long COVID
Remaining events with vaccination, NHR
Events averted with vaccination, NHR
Remaining events with vaccination, HR
Events averted with vaccination, HR
HR = high risk; NHR = non -high risk
Incremental cost -effectiveness ratios (ICERs), 2025 -2026
vaccination, per cohort of 1,000,000
15Age Strategy CostIncremental
costQALYsIncremental
QALYs$/QALY
Non -high -risk
18 - 49 yNo vaccination $121,084,319 - 20,208,352 - -
Vaccination $292,804,184 $171,719,865 20,208,697 345 $498,090
50 - 64 yNo vaccination $172,993,823 - 12,278,283 - -
Vaccination $329,875,771 $156,881,948 12,278,676 393 $398,809
>65 yNo vaccination $213,552,333 - 6,526,870 - -
Vaccination $345,570,759 $132,018,426 6,527,758 887 $148,811
High -risk
18 - 49 yNo vaccination $166,726,302 - 20,208,138 - -
Vaccination $323,381,110 $156,654,808 20,208,555 417 $375,399
50 - 64 yNo vaccination $295,589,269 - 12,277,500 - -
Vaccination $411,159,262 $115,569,993 12,278,163 663 $174,359
>65 yNo vaccination $395,948,683 - 6,524,593 - -
Vaccination $467,984,279 $72,035,596 6,526,248 1655 $43,537
QALY = quality -adjusted life year
Base -case and probabilistic sensitivity analyses, 2025 -2026
vaccination
AgeICER ($/QALY)
Base case 95% confidence interval
Non -high -risk
18 - 49 y $498,090 $309,220 - $913,905
50 - 64 y $398,809 $252,690 - $691,360
>65 y $148,811 $78,132 - $276,981
High -risk
18 - 49 y $375,399 $232,241 - $659,757
50 - 64 y $174,359 $66,920 - $388,115
>65 y $43,537 Cost -saving - $142,478
16ICER = incremental cost effectiveness ratio; QALY = quality -adjusted life year
Number needed to vaccinate (NNV), 2025 -2026 vaccination,
base case
AgeNNV to
avert a caseNNV to
avert a
hospitalization NNV to
avert a death
Non -high -risk
18 - 49 y 15 15,746 1,133,330
50 - 64 y 16 4,897 145,755
>65 y 12 778 14,818
High -risk
18 - 49 y 15 3,351 241,229
50 - 64 y 16 1,227 36,522
>65 y 12 296 5,642
17
Cost/outcome averted, 2025 -2026 vaccination, base case
Age $/Case averted$/Hospitalization
averted$/Death averted
Non -high -risk
18 - 49 y $2,504 $2,703,838 $194,615,325
50 - 64 y $2,474 $768,180 $22,866,393
>65 y $1,540 $102,729 $1,956,219
High -risk
18 - 49 y $2,282 $525,021 $37,789,676
50 - 64 y $1,817 $141,797 $4,220,853
>65 y $836 $21,344 $406,450
18
One-way sensitivity analysis, >65 years, non -high -risk
19$/QALY gained with variable at upper bound $/QALY gained with variable at lower bound$0 $100,000 $200,000 $300,000 $400,000Time to receive vaccine, pharmacyProbability, outpatient visit given symptomatic COVIDCost, vaccine administrationLifetime productivity costTime to receive vaccine, doctor's officeProbability, symptomatic illnessQuality adjustment, symptomatic COVIDCost, vaccine doseProbability, hospitalizationSAVI against symptomatic COVID, hospitalization, critical illness
$/QALY
Base case: $148,811/QALY
SAVI = seasonality -adjusted vaccine impact
One-way sensitivity analysis: probability of hospitalization
AgeICER ($/QALY)
Lower bound Base case Upper bound
Non -high -risk
18 - 49 y $526,249 $498,090 $466,186
50 - 64 y $501,595 $398,809 $306,095
>65 y $267,505 $148,811 $81,894
High -risk
18 - 49 y $477,426 $375,399 $284,883
50 - 64 y $368,234 $174,359 $68,386
>65 y $157,467 $43,537 Cost -saving
20ICER = incremental cost effectiveness ratio; QALY = quality -adjusted life year
Scenario analysis: vaccine dose cost, 2025 -2026 vaccination
AgeICER ($/QALY)
$30 $60 $90 $120 Base case $150
Non -high -risk
18 - 49 y $181,113 $268,131 $355,149 $442,166 $498,090 $529,184
50 - 64 y $121,009 $197,272 $273,535 $349,798 $398,809 $426,061
>65 y $25,631 $59,447 $93,262 $127,078 $148,811 $160,894
High -risk
18 - 49 y $113,526 $185,417 $257,307 $329,198 $375,399 $401,088
50 - 64 y $9,490 $54,750 $100,011 $145,272 $174,359 $190,532
>65 y Cost -saving Cost -saving $13,753 $31,885 $43,537 $50,016
21ICER = incremental cost effectiveness ratio; QALY = quality -adjusted life year
Base case: $139.28
Age >18 private sector prices: Moderna $141.80; Pfizer $136.75
Accounting for Vaccine Wastage in Cost -
effectiveness Analyses
22•Few CEAs include wastage as a separate cost in the analysis
•Conventional assumption is that any costs associated with wastage are
reflected in the price per dose (if returns are allowed) or the administration
fee (if provider bears the cost of unused doses)
•Scenario analysis on price per dose yields insights if wastage is not adequately
captured by base case assumptions
Limitations
23•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 y only includes those with supplemental
insurance
•Evidence base for long COVID is especially scarce
•Model does not include reduced transmission (conservative approach)
Summary
•Vaccination averts morbidity and mortality for all age and risk groups
•Substantial variation in impact by age and risk status
•Overall economic favorability has declined compared to estimates from earlier
seasons due to declining burden of illness
•ICERs for ≥65 y age group [HR: $44,000/QALY; NHR: $149,000/QALY] are robust to
changes in parameter inputs across plausible ranges [HR: Cost -saving -$142,000/QALY;
NHR: $78,000/QALY -$277,000/QALY]
•ICERs for 18 -49 y and 50 -64 y age groups are sensitive to changes in parameter
inputs and favorable only under certain conditions for high -risk 50 -64 y
24
Questions
25