The Fiscal Case for Investing in COVID-19 Vaccination: A UK Treasury Perspective
Author(s)
George Bray, MSc1, Simon Brassel, MSc1, Jingyan Yang, DrPH2, Charlotte Leversha, MSc3, Cale Harrison, MS3, Tianyan Hu, PhD2, Margherita Neri, MSc4, Lotte Steuten, PhD1.
1Office of Health Economics, London, United Kingdom, 2Pfizer Inc., New York, NY, USA, 3Pfizer Inc., London, United Kingdom, 4Verian Group, Brussels, Belgium.
1Office of Health Economics, London, United Kingdom, 2Pfizer Inc., New York, NY, USA, 3Pfizer Inc., London, United Kingdom, 4Verian Group, Brussels, Belgium.
OBJECTIVES: The cost-effectiveness of COVID-19 vaccination and its wider societal benefits are well established. However, limited government budgets make it important to also understand the fiscal returns to the UK Treasury of investing public funds in COVID-19 vaccination programmes. This study estimates the fiscal return on investment (ROI) of current COVID-19 vaccination coverage when compared to a no vaccination scenario across four working-age population groups aged 18-64: not in clinical risk groups (not at-risk, NAR); in clinical risk groups (at-risk, AR); health and social care workers (HCW); and informal caregivers.
METHODS: We developed a de novo Fiscal Health Model linking a multi-cohort Markov model with the disease states susceptible; infected; and long COVID (>6months post-infection) to five fiscal states. Time spent in each health-fiscal state combination determines fiscal inflows (i.e. direct, indirect taxes) and outflows (e.g. benefits, pensions, healthcare costs) to the UK Treasury over an individual’s working-age (excluding retirement) and total lifetime (including retirement), which were used to calculate fiscal benefit-cost ratios (fBCR) and net fiscal benefits (fNB). Disease model inputs were based on sources covering both Delta and Omicron periods.
RESULTS: COVID-19 vaccination yields a positive ROI (fBCR>1) for those aged 18-64 AR (fBCR: 1.32/fNB: £286.2m), HCW (1.46/ £144.8m), and informal caregivers (1.54/£212.8m) before retirement. ROIs become positive within 5 years but lower when the retirement phase is considered as fiscal outflows (e.g. state pensions) increase due to averted COVID-19 mortality. For those NAR, who were previously eligible for boosters, COVID-19 vaccination approximates cost-neutrality (0.98/-£24.4m) prior to retirement.
CONCLUSIONS: COVID-19 vaccination of 18-64-year-olds generates a positive fiscal ROI to the UK Treasury, notably among HCW, informal caregivers, and people AR, which accumulates quickly and decreases after retirement age. This fiscal health analysis complements standard cost-effectiveness analysis and provides evidence to support public funding of COVID-19 vaccination for the UK government.
METHODS: We developed a de novo Fiscal Health Model linking a multi-cohort Markov model with the disease states susceptible; infected; and long COVID (>6months post-infection) to five fiscal states. Time spent in each health-fiscal state combination determines fiscal inflows (i.e. direct, indirect taxes) and outflows (e.g. benefits, pensions, healthcare costs) to the UK Treasury over an individual’s working-age (excluding retirement) and total lifetime (including retirement), which were used to calculate fiscal benefit-cost ratios (fBCR) and net fiscal benefits (fNB). Disease model inputs were based on sources covering both Delta and Omicron periods.
RESULTS: COVID-19 vaccination yields a positive ROI (fBCR>1) for those aged 18-64 AR (fBCR: 1.32/fNB: £286.2m), HCW (1.46/ £144.8m), and informal caregivers (1.54/£212.8m) before retirement. ROIs become positive within 5 years but lower when the retirement phase is considered as fiscal outflows (e.g. state pensions) increase due to averted COVID-19 mortality. For those NAR, who were previously eligible for boosters, COVID-19 vaccination approximates cost-neutrality (0.98/-£24.4m) prior to retirement.
CONCLUSIONS: COVID-19 vaccination of 18-64-year-olds generates a positive fiscal ROI to the UK Treasury, notably among HCW, informal caregivers, and people AR, which accumulates quickly and decreases after retirement age. This fiscal health analysis complements standard cost-effectiveness analysis and provides evidence to support public funding of COVID-19 vaccination for the UK government.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH235
Topic
Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
Vaccines