EVALUATING THE IMPACT OF MONETARY INCENTIVES ON HEALTH EQUITY : A DISTRIBUTIONAL COST-EFFECTIVENESS ANALYSIS OF COVID-19 VACCINATION STRATEGIES
Author(s)
Jae Man Park, Ph.D.1, Henry Brown, Ph.D.1, David R. Lairson, Ph.D.1, Youngran Kim, Ph.D.2, Lilac Li, Ph.D.3;
1UTHealth Houston School of Public Health, Houston, TX, USA, 2University of Texas School of Public Health, Houston, TX, USA, 3University of Nebraska Kearney, Kearney, NE, USA
1UTHealth Houston School of Public Health, Houston, TX, USA, 2University of Texas School of Public Health, Houston, TX, USA, 3University of Nebraska Kearney, Kearney, NE, USA
OBJECTIVES: Monetary incentives have been used in United States to boost COVID-19 vaccination rates, while still little known about their cost-effectiveness and the effects on health. This study aims to evaluate the impact of these incentives on overall health, costs, and equity across racial and socially vulnerable subgroups.
METHODS: Using data from Our World in Data and baseline health inequality from Kowal et al, 2023, we conducted Distributional Cost-Effectiveness Analysis from a public-payer perspective to assess how four COVID-19 vaccine incentive programs: cash incentives of $25, $50, and $100 dollars and a lottery compared with no incentive affected health outcomes across 25 subgroups defined by race and social vulnerability. We derived aggregated health outcomes, including infections, deaths, costs, and additional vaccinations, from a SVIR model. Program expenses were transformed into health opportunity costs using cost-effectiveness threshold and distributed with opportunity-cost weights designed to protect more socially vulnerable groups partially. Net health benefit was calculated as Health-Adjusted Life Years (HALYs) gained minus health opportunity costs. Efficiency was summarized by total HALYs, and equity was evaluated using the Atkinson equally distributed equivalent measure of per capita NHB with ε equal to 10.
RESULTS: We found that all vaccination incentive strategies improved population health compared to no incentive. When considering a threshold value of $150,000 per Quality-Adjusted Life Year, the lottery approach was not only cost-saving but also delivered moderate health benefits and the fairest distribution of net health outcomes. The $100 cash incentive resulted in the greatest overall health improvement, though it was also the costliest and created unequal distribution of benefits. The Atkinson equity penalty heatmaps revealed substantial equity losses for White subgroups in the mid-range of the Social Vulnerability Index, whereas highly vulnerable Asian and Pacific Islander subgroups gained more NHB.
CONCLUSIONS: Lottery programs offer cost-effective, equitable benefits for resource-constrained settings or equity-focused policymaking.
METHODS: Using data from Our World in Data and baseline health inequality from Kowal et al, 2023, we conducted Distributional Cost-Effectiveness Analysis from a public-payer perspective to assess how four COVID-19 vaccine incentive programs: cash incentives of $25, $50, and $100 dollars and a lottery compared with no incentive affected health outcomes across 25 subgroups defined by race and social vulnerability. We derived aggregated health outcomes, including infections, deaths, costs, and additional vaccinations, from a SVIR model. Program expenses were transformed into health opportunity costs using cost-effectiveness threshold and distributed with opportunity-cost weights designed to protect more socially vulnerable groups partially. Net health benefit was calculated as Health-Adjusted Life Years (HALYs) gained minus health opportunity costs. Efficiency was summarized by total HALYs, and equity was evaluated using the Atkinson equally distributed equivalent measure of per capita NHB with ε equal to 10.
RESULTS: We found that all vaccination incentive strategies improved population health compared to no incentive. When considering a threshold value of $150,000 per Quality-Adjusted Life Year, the lottery approach was not only cost-saving but also delivered moderate health benefits and the fairest distribution of net health outcomes. The $100 cash incentive resulted in the greatest overall health improvement, though it was also the costliest and created unequal distribution of benefits. The Atkinson equity penalty heatmaps revealed substantial equity losses for White subgroups in the mid-range of the Social Vulnerability Index, whereas highly vulnerable Asian and Pacific Islander subgroups gained more NHB.
CONCLUSIONS: Lottery programs offer cost-effective, equitable benefits for resource-constrained settings or equity-focused policymaking.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE89
Topic
Economic Evaluation
Disease
SDC: Infectious Disease (non-vaccine), STA: Vaccines