Missed Opportunities? Gaps in Capturing the Full Value of Vaccination Across Health Economic Studies of COVID-19 Vaccination

OBJECTIVES: COVID-19 pandemic has emphasized the significant health and socio-economic value of vaccination (VoV) to society including its impact on macroeconomics, health systems strengthening, and health equity. This systematic review aims to summarize published economic models of COVID-19 vaccination and assess whether they considered broader VoV elements.

METHODS: A systematic search in Medline, EMBASE, EconLit and the International Network of Agencies for Health Technology Assessment was performed. Cost-effectiveness and cost-benefit analyses of COVID-19 vaccination published from January 2019 to September 2023 were included (PROSPERO registration: CRD42023470154). VoV was assessed based on a generic VoV framework (Postma et al. Vaccine. 2022; Beck et al. Vaccine. 2022).

RESULTS: A total of 56 models were included. Models were predominantly from North America (n=18) and the Asia-Pacific (n=16) region and adopted a dynamic transmission (n=23), Markov (n=10) or decision tree (n=8) approach. Almost 70% studies (n=39) found COVID-19 vaccination to be either cost-effective or cost-saving. Most studies (n=50) reported outcomes relating to the conventional payer’s perspective (e.g., individual and societal health gains and medical costs), while eight also considered the conventional societal perspective (e.g., health-related productivity gains). Only three studies included broader socioeconomic concepts i.e., reported macroeconomic gains from resumption of social and economic activity due to businesses re-opening, increased employment/earnings and increased productivity of the workforce when people no longer work remotely or assist their children with online school.

CONCLUSIONS: COVID-19 vaccination has been shown to be highly cost-effective or cost-saving; however, economic evaluations of COVID-19 vaccination have substantially lacked the inclusion of broader VoV elements. As the COVID-19 pandemic transitions into the endemic phase, it warrants the discussion of considering novel socioeconomic concepts in future economic analyses such as macroeconomic gains, minimizing healthcare systems disruptions and increasing capacity, ensuring financial risk protection for caregivers, and reducing health and financial equity gaps.