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.
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References
- Dong E., Du H., Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20(5):533–534. [published correction appears in Lancet Infect Dis. 2020;20(9):e215]
- Davies N., Kucharski A., Eggo R., Gimma A., Edmunds W. Centre for the Mathematical Modelling of Infectious Diseases COVID-19 working group. Effects of non-pharmaceutical interventions on COVID-19 cases, deaths, and demand for hospital services in the UK: a modelling study. Lancet Public Health. 2020;5(7):e375–e385.
- Flaxman S., Mishra S., Gandy A., et al. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature. 2020;584(7820):257–261.
- Voysey M., Clemens S., Madhi S., et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of 4 randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021;397(10269):99–111.
- Baden L., El Sahly H., Essink B., et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021;384(5):403–416.
- Dagan N., Barda N., Kepten E., et al. BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting. N Engl J Med. 2021;384(15):1412–1423.
- Polack F., Thomas S., Kitchin N., et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;383(27):2603–2615.
- Knoll M., Wonodi C. Oxford–AstraZeneca COVID-19 vaccine efficacy. Lancet. 2021;397(10269):72–74.
- Li Q., Guan X., Wu P., et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199–1207.
- Global economic prospects. Resumen. . Accessed December 23, 2020.
- Institute for Health Metrics and Evaluation . University of Washington. Healthdata – Global Burden of Disease. University of Washington; 2021.
- Ministerio de Salud y Protección Social Base de Datos Única de Afiliados (BDUA). 2012-2020;Vol 2020.
- Ministerio de Salud y Protección Social Departamento Administrativo Nacional de Estadística. Estadísticas Vitales. 2012-2019;Vol 2020.
- Briggs A., Claxton K., Sculpher M. Oxford University Press; Oxford, United Kingdom: 2006. Decision modelling for health economic evaluation.
- Ministerio de Salud y Protección Social. Base de datos de la Suficiencia del Aseguramiento en Salud. Vol. 2021; 2012-2018.
- Ministerio de Salud y Protección Social Base de Datos del Registro Único Nacional de Talento Humano en Salud. (ReTHUS). 2020.
- Verity R., Okell L., Dorigatti I., et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669–677. [published correction appears in Lancet Infect Dis. 2020;20(6):e116]
- Instituto Nacional de Salud Base de datos de Casos. COVID-19 en Colombia; 2020.
- Prem K., Cook A., Jit M. Projecting social contact matrices in 152 countries using contact surveys and demographic data. PLoS Comput Biol. 2017;13(9)
- Google. COVID-19 Community Mobility Reports.
- Mutual Ser EPS. Mutual Ser EPS COVID-19 recorded cases. 2020.
- Departamento Administrativo Nacional de Estadística . Vol. 2021. 2020. Producto Interno Bruto – Datos actualizados para.
- Departamento Administrativo Nacional de Estadística, editor. Departamento Administrativo Nacional de Estadística; 2018. (Censo Nacional de Poblacion y Vivienda 2018).
- Nelder J., Mead R. A simplex method for function minimization. Comput J. 1965;7(4):308–313.
- Huang Y., McColl W. Improved simplex method for function minimization. Proc IEEE Int Conf Syst Man Cybern. 1996;3:1702–1705.
- Davies N., Abbott S., Barnard R., et al. Estimated transmissibility and impact of SARS-CoV-2 lineage B.1.1.7 in England. Science. 2021;372(6538) eabg3055.
Source: PubMed