Cost effectiveness analysis of mRNA Covid-19 vaccine versus inactivated Covid-19 vaccine for averting deaths in mass vaccination in Jordan

Background: There are many types of COVID-19 vaccines used to curb the COVID-19 pandemic, but they differ in efficacy, price, and handling requirements. Health economic evaluation is required to ascertain the more cost-effective vaccination strategy in averting deaths during a pandemic from provider’s perspective in Jordan to use the Jordanian resources efficiently. Methods: Extended SEIR (Susceptible-Exposed-Infectious-Removed) models were used to show and understand the predicted progression of COVID-19 with and without vaccination strategy. The extended SEIR model is a sophisticated epidemiological framework designed to provide a comprehensive understanding of infectious disease dynamics. Then, the cost-effectiveness analysis was conducted to compare mass-vaccination strategies using mRNA and inactivated COVID-19 vaccines, against no vaccination, from the perspective of the healthcare provider in Jordan. The cost-effectiveness analysis utilized a decision-tree model, developed using TreeAge Software. The model population was all population of Jordan aged 18 years and older in the year 2021. The costs were that of vaccination strategies which include procurement, management, and administration of the vaccines, as well as treatment for COVID-19 including hospitalization. Costs were measured in Jordanian dinars. The outcome measure was death due to COVID-19, averted. CEA was conducted based on both primary and secondary data. Primary data was collected to determine vaccination-related costs and treatment costs associated with materials using micro-costing method, while secondary data was used to estimate probabilities and parameters for the models, and published costs were used whenever primary data was unavailable. The number of deaths for each of the vaccination strategy was subtracted from the number of deaths of no-vaccination strategy to calculate the number of deaths averted. To account for uncertainty, sensitivity and scenario analyses were performed. Results: The extended SEIR models showed that over time, there were periods where the number of infected cases peaked followed by a plateau, and that the number of cases and deaths were higher with no vaccination compared to with vaccination. In terms of cost-effectiveness analysis (CEA), the total costs associated with mRNA vaccination strategy, inactivated vaccination strategy, and no vaccination strategy were 339,035,352.00 JOD (478,188,084.63 USD), 643,192,339.62 JOD (907,182,425.41 USD), and 1,110,731,145.64 JOD (1,566,616,566.48 USD), respectively. The respective effects of these strategies were estimated as 952, 6,505, and 29,324 deaths. The mRNA strategy is the dominant strategy with an incremental cost-effectiveness ratio (ICER) of -27,199.20 JOD (-38,362.76 USD) per death averted, while inactivated strategy with an ICER of -20,489.01 JOD (-28,898.46 USD) per death averted. Furthermore, when comparing mRNA to the inactivated strategy, the ICER was - 54,773.45 JOD (-77,254.51 USD) saved per each additional death averted. Deterministic sensitivity analysis shows that the mRNA strategy remained dominant despite variations in the analysis, when compared to both the no vaccination and inactivated strategies, indicating robust results. Even in the worst-case scenario, the ICER of mRNA remained cost-saving, while the inactivated strategy yielded more costs and deaths compared to no vaccination. Conclusion: In the context of this study, vaccination significantly reduced COVID-19 impact, leading to fewer cases and deaths compared to no vaccination, by using extended SEIR models. Additionally, in terms of CEA, the mRNA vaccination strategy was more dominant compared to vaccination strategy using inactivated vaccine and no-vaccination strategy in averting deaths.

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