The cost-effectiveness of vaccination against COVID-19 illness during the initial year of vaccination

Lisa A Prosser; Janamarie Perroud; Grace S Chung; Acham Gebremariam; Cara B Janusz; Kerra Mercon; Angela M Rose; Anton L V Avañcena; Ellen Kim DeLuca; David W Hutton

doi:10.1016/j.vaccine.2025.126725

The cost-effectiveness of vaccination against COVID-19 illness during the initial year of vaccination

Vaccine. 2025 Jan 21:48:126725. doi: 10.1016/j.vaccine.2025.126725. Online ahead of print.

Authors

Affiliations

¹ Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; Susan B. Meister Child Health and Evaluation Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: [email protected].
² Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.
³ Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
⁴ Susan B. Meister Child Health and Evaluation Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.
⁵ Susan B. Meister Child Health and Evaluation Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Implementation Science, Wake Forest University School of Medicine, Winston Salem, NC, USA.
⁶ Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
⁷ Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA.

PMID: 39842151
DOI: 10.1016/j.vaccine.2025.126725

Abstract

Background: Substantial investments by government programs and private health plans subsidized the costs of COVID-19 vaccine doses and vaccine administration. The objective of this study was to evaluate the cost-effectiveness of vaccination against COVID-19 illness during the initial year of COVID-19 vaccination (2021).

Methods: Using a simulation model, we projected outcomes for hypothetical cohorts of US adults aged 18 and older, stratified by age and risk status for complications, comparing vaccination and no vaccination in the context of recommended concomitant prevention strategies (e.g., masking, social distancing). Vaccination against COVID-19 illness and complications used a pooled vaccination strategy for the 3 products available in 2021. Primary outcome measures included incremental cost-effectiveness ratio (ICER), projected costs, and projected quality-adjusted life years (QALYs). The model was parameterized using US epidemiologic, clinical, and cost data and the analysis used the healthcare and societal perspectives.

Results: For vaccination against COVID-19 illness compared with no vaccination, vaccination yielded cost savings and QALY gains for all adult age and risk groups using the societal perspective. Using a healthcare sector perspective, ages 18-39 years required a net investment with ICERs ranging from $8400 to $15,000/QALY. Scenarios evaluating vaccine incentive programs mostly yielded ICERs <$100,000/QALY except for worker bonuses of $500 which yielded ICERs of $22,000 to $134,000/QALY. Results were most sensitive to costs of vaccination (dose cost, administration cost, travel and vaccination time costs) across uncertainty analyses.

Conclusion: Investment in the 2021 vaccination program was attractive from an economic perspective even when using a very conservative approach to the analysis. Future vaccination programs in the US, with different associated cost structures, should be assessed to ensure ongoing value for COVID-19 vaccination.

Keywords: COVID-19; Cost-effectiveness analysis; Vaccination.