The potential clinical impact and cost-effectiveness of the updated COVID-19 mRNA Fall 2023 vaccines in the United States

Abstract

Objectives: To assess the potential clinical impact and cost-effectiveness of COVID-19 mRNA vaccines updated for Fall 2023 in adults ≥18 years over a 1-year analytic time horizon (September 2023-August 2024). Methods: A compartmental Susceptible-Exposed-Infected-Recovered model was updated to reflect COVID-19 in summer 2023. Numbers of symptomatic infections, COVID-19 related hospitalizations and deaths, and costs and quality-adjusted life-years (QALYs) gained were calculated using a decision tree model. The incremental cost-effectiveness ratio (ICER) of a Moderna updated mRNA Fall 2023 vaccine (Moderna Fall Campaign) was compared to no additional vaccination. Potential differences between the Moderna and the Pfizer-BioNTech Fall 2023 vaccines were examined. Results: Base case results suggest the Moderna Fall Campaign would decrease the expected 64.2 million symptomatic infections by 7.2 million (11%) to 57.0 million. COVID-19-related hospitalizations and deaths are expected to decline by 343,000 (-29%) and 50,500 (-33%), respectively. The Moderna Fall Campaign would increase QALYs by 740,880 and healthcare costs by $5.7 billion relative to No Vaccine, yielding an ICER of $7,700 per QALY gained. Using a societal cost perspective, the ICER is $2,100. Sensitivity analyses suggest that vaccine effectiveness, COVID-19 incidence, hospitalization rates and costs drive cost-effectiveness. With a relative vaccine effectiveness (rVE) of Moderna versus Pfizer-BioNTech of 5.1% for infection and 9.8% for hospitalization, use of the Moderna vaccine is expected to prevent 24,000 more hospitalizations and 3,300 more deaths than the Pfizer-BioNTech vaccine. Limitations and Conclusions: As COVID-19 becomes endemic, future incidence, including patterns of infection, are highly uncertain. Vaccine effectiveness of Fall 2023 vaccines is unknown, and it is unclear when a new variant that evades natural or vaccine immunity will emerge. Despite these limitations, the Moderna Fall 2023 vaccine can be considered cost-effective relative to no vaccine.

Clinical impact and cost-effectiveness of the updated COVID-19 mRNA Autumn 2023 vaccines in Germany

“…A previously developed [29] Susceptible-Exposed-Infected-Recovered (SEIR) model was adapted to assess the clinical impact of an mRNA-1273.815 vaccination campaign in Germany. A decision tree was then used to calculate, based on the predicted number of infections from the SEIR model, the numbers of symptomatic infections, COVID-19 related outpatient visits, COVID-19-related hospitalizations, COVID-19-related deaths, quality-adjusted life-years (QALYs) gained, as well as corresponding medical and societal costs for each vaccination strategy.…”

“…We used an age-stratified SEIR compartmental model adapted from Shiri et al, which has been described elsewhere [29,30]. Briefly, we assumed individuals are initially susceptible (S) and move to an exposed or latent state (E) after an effective contact with an infectious individual.…”

“…The mRNA-1273.815 campaign was modelled for the 4-month period from September 2023 to December 2023 for individuals who received the primary series, irrespective of the quantity or type of boosters received previously [3]. Full model details including equations and inputs are described in the Technical Appendix of this publication and in a separate Technical Appendix developed by Kohli et al [29].…”

“…In addition to the base case scenario described above, additional calibrations were performed to allow the proportion of individuals with natural immunity and relative amount of residual VE against infection and hospitalisation to vary prior to the start of the analytic time period. Similar to that described in Kohli et al [29], the waning rate of natural protection from SARS-CoV-2 infection was varied and the model was recalibrated to the same level as the base case.…”

“…Nevertheless, in view of the changes to the epidemiological, clinical, and financial dimensions of COVID-19 vaccines, it remains important to determine if the use of COVID-19 vaccines is cost-effective [29], to better inform policy-makers about the overall burden of COVID-19 and the efficient vaccination strategies.…”