Cost-Effectiveness Analysis of Strategies of COVID-19 Vaccination in Colombia: Comparison of High-Risk Prioritization and No Prioritization Strategies With the Absence of a Vaccination Plan

Gilberto Morales-Zamora, Oscar Espinosa, Edwin Puertas, Juan Carlos Fernández, José Hernández, Verónica Zakzuk, Magda Cepeda, Nelson Alvis-Gúzman, Carlos Castañeda-Orjuela, Angel Paternina-Caicedo, Gilberto Morales-Zamora, Oscar Espinosa, Edwin Puertas, Juan Carlos Fernández, José Hernández, Verónica Zakzuk, Magda Cepeda, Nelson Alvis-Gúzman, Carlos Castañeda-Orjuela, Angel Paternina-Caicedo

Abstract

Objectives: Our study compares two national COVID-19 vaccination plan strategies-high-risk prioritization and no prioritization-and estimates their cost-effectiveness compared with no vaccination, to generate possible recommendations for future vaccination plans.

Methods: We developed a Markov discrete-time, compartmental, deterministic model stratified by Colombian departments, healthcare workers, comorbidities, and age groups and calibrated to seroprevalence, cases, and deaths. The model simulates three scenarios: no vaccination, no prioritization of vaccination, and prioritization of high-risk population. The study presents the perspective of the health system of Colombia, including the direct health costs financed by the government and the direct health outcomes related to the infection. We measured symptomatic cases, deaths, and costs for each of the three scenarios from the start of the vaccination rollout to February 20, 2023.

Results: Both for the base-case and across multiple sensitivity analyses, the high-risk prioritization proves to be the most cost-effective of the considered strategies. An increment of US$255 million results in an incremental cost-effectiveness ratio of US$3339 per disability-adjusted life-year avoided. The simulations show that prioritization of high-risk population reduces symptomatic cases by 3.4% and deaths by 20.1% compared with no vaccination. The no-prioritization strategy is still cost-effective, with an incremental cost-effectiveness ratio of US$5223.66, but the sensitivity analysis the show potential risks of losing cost-effectiveness under the cost-effectiveness threshold (one gross domestic product per averted disability-adjusted life-year).

Conclusions: The high-risk prioritization strategy is consistently more cost-effective than the no-prioritization strategy across multiple scenarios. High-risk prioritization is the recommended strategy in low-resource settings to reduce the burden of disease.

Keywords: Colombia; cost-effectiveness; modeling; severe acute respiratory syndrome coronavirus 2; vaccination.

Copyright © 2022 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Cost-effectiveness plane for the base-case scenarios and top 4 relevant common parameters in the tornado analysis according to the ICER. Panel A shows how high-risk prioritization has both less costs and higher benefits. Panel B shows the scenarios of avoided cost and DALYs in different scenarios in the cost-effectiveness plane. DALY indicates daily-adjusted life-year; GDP, gross domestic product; ICER, incremental cost-effectiveness ratio; K, thousand; M, million.
Figure 2
Figure 2
Percentage of deaths by age group, according to the vaccination scenario. Panel A shows what would occur in the no-vaccination scenario, Panel B in the high-risk scenario, and Panel C in the no-prioritization scenario. Panel B shows the shift in the age distribution of deaths to younger ages when prioritizing older ages. In Panel C, given that the allocation of vaccines is random, there is no large change in the distribution with higher vaccination coverage. Apr indicates April; Jan, January; Jul, July; Oct, October.
Figure 3
Figure 3
Tornado analysis of the ICER for each vaccination strategy. Panel A shows the probability of having symptoms among infected older than 70 years changes the model the most in the high-risk prioritization scenario. Panel B shows that the assumed immunity loss every year provides the most significant uncertainty in the scenario without prioritization of COVID-19 vaccination. DALY indicates daily-adjusted life-year; ICER, incremental cost-effectiveness ratio; ICU, intensive care unit; IFR, infection fatality rate; USD, US dollar.
Figure 4
Figure 4
Cost-effectiveness plane for the uncertainty analyses. Apr indicates April; DALY, daily-adjusted life-year; GDP, gross domestic product; Jan, January; Jul, July; K, thousand; M, million; Oct, October.

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Source: PubMed

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