OBJECTIVES: COVID-19 led to a global pandemic in 2020. Vaccines were developed with price points based on health policies defined under state of emergency declarations. As countries lift their state of emergency, price points may adopt a value-based approach. The aim of this research was to identify cost-effectiveness metrics expected to guide value-based negotiations for upcoming COVID-19 vaccines.

METHODS: A systematic search in PubMed was conducted to identify peer-reviewed cost-effectiveness evaluations on COVID-19 vaccines published since January 2020. Literature that met eligibility criteria was reviewed to identify clinical, health outcome, and economic metrics, price points, and ICER-sensitive metrics related to cost-effectiveness evaluations.

RESULTS: A total of 331 articles were identified and screened. Of these, 21 cost-effectiveness evaluations were reviewed for the research. The most common health outcome metric was QALY (n=12). The most common clinical metrics were mortality (n=12) and ICU admission rate (n=12). The most common economic metrics were drug acquisition cost (n=15), hospital admission cost (n=11), and vaccine administration costs (n=10). The vaccination cost per dose ranged from $3.7-$47.0 USD (adjusted by purchasing power parity), with mRNA-based vaccines showing the highest price points. The most common factors driving ICER values were drug acquisition cost (n=4), vaccine efficacy (n=3), rate of vaccination (n=3), infection rate (n=3), and hospitalization cost (n=2). Willingness-to-pay (WTP) thresholds globally ranged from $9,000-$150,000 per QALY and were defined based on HTA agency guidelines, WHO recommendation, international reference, or published literature.

CONCLUSIONS: As the global health crisis subsides, policy-makers may adopt alternative pricing approaches for COVID-19 vaccines. Considering the value-based pricing approach, optimizing cost-effectiveness strategies becomes critical. As part of these strategies, clinical trials should be designed to capture the most relevant cost-effectiveness metrics. Moreover, both price-sensitive parameters and national HTA and international WTP recommendations should be considered when assessing potential price points within the cost-effectiveness models.