OBJECTIVES: An investigational next-generation bivalent SARS-CoV-2 booster (mRNA-1273.214) demonstrated superior neutralizing antibody titers against Omicron, and higher binding antibody titers against other variants (Alpha, Beta, Gamma, Delta), compared to the original monovalent vaccine (mRNA-1273). Results are consistent for the emerging Omicron sub-lineages BA.4 and BA.5 likely to dominate COVID-19 cases during the Fall 2022 season. Our objective was to estimate the potential incremental benefits of boosting with mRNA-1273.214 in September 2022 in Germany in (a) adults ≥18 years and (b) adults ≥60 years, compared to mRNA-1273.

METHODS: We developed a static decision tree model to estimate the annual cases of COVID-19 and their consequences in Germany for 100,000 persons vaccinated with mRNA-1273.214 compared to mRNA-1273. Vaccine effectiveness against symptomatic infection and hospitalization over the 1-year time horizon was estimated using models of neutralizing antibody levels, assuming Omicron variants BA.4 and BA.5 will be predominant. Incidence projections, resource use and health care costs were derived for a German setting.

RESULTS: We estimated there would be 268 hospitalizations and 62 deaths for every 100,000 Germans aged ≥18 years if vaccinated with the monovalent booster. Boosting with the bivalent booster instead of the monovalent would reduce hospitalizations by 27 and deaths by 7 per 100,000 vaccinated. Compared to the mRNA-1273, COVID-19 treatment costs would be reduced by €496,000 per 100,000 persons with bivalent booster use. For adults ≥60 years, use of the bivalent booster would lead to a reduction of 62 hospitalizations, 18 deaths and €1,122,000 in COVID-19 treatment costs for every 100,000 vaccines administered compared to the monovalent booster.

CONCLUSIONS: The broad immune response associated with the next generation bivalent vaccine is expected to avert more hospitalizations, deaths, and treatment costs if Omicron BA.4 and BA.5 are circulating in Germany, especially amongst adults aged ≥60 years.