OBJECTIVES: We estimated the cost-effectiveness of non-pharmaceutical interventions (NPI), vaccines, and the combination of NPI and vaccines in managing the COVID pandemic.

METHODS: A dynamic transmission model was constructed to simulate the incidence of COVID infections and deaths among community-dwelling Singapore residents. Using this model, we compared the cost and outcomes of NPI (border control measures, safe distancing and mask wearing) versus no NPI in an unvaccinated and a vaccinated population. The analysis was conducted from the societal perspective over a one year time horizon, with data based on the COVID situation in Singapore during Jan 2021 to Dec 2021. Costs of vaccination, adverse events, masks, self-testing using rapid antigen tests, test-trace-isolate (TTI), outpatient visits, hospitalization, productivity loss and reduced sales receipt from retail and food and beverages industries were included. Health loss from adverse events, TTI and COVID infection and deaths were also included.

RESULTS: Among the scenarios compared, vaccination combined with NPIs yield the lowest cost (S$7.6 billion), while no vaccination with NPIs had the highest costs (S$49.1 billion). The largest loss in QALYs from the population was seen from the scenario without vaccination or NPIs. Using a dominance approach, vaccination combined with NPIs is cost saving with an ICER of -S$213 billion per QALY, compared to no vaccination with lockdown measures.

The results show that NPIs alone without vaccination only delays transmission, but does not significantly change the total number of cases observed in the population. Vaccination is both cost saving and health saving as the difference in cases averted from vaccination and their associated costs, is far greater than the additional costs required to vaccinate the public.

CONCLUSIONS: Both vaccination and NPI are critical strategies for managing the COVID pandemic. In the presence of vaccine, NPIs continue to offer benefits in terms of reduced number of infections and deaths.