OBJECTIVES: The United Kingdom (UK) implemented an autumn 2022 booster programme that allowed those at higher risk from COVID-19, including those ≥ 50 years, to receive a booster to increase protection against infection and subsequent severe outcomes. As the UK transitions out of the pandemic, future booster campaigns may be required to maintain protection against such outcomes. The objective of this analysis was to estimate the value-based price (VBP) for a bivalent COVID-19 vaccine used in a future autumn 2023 campaign in the UK to protect people aged ≥ 50 years.

METHODS: A Susceptible-Exposed-Infected-Recovered (SEIR) model was used to predict infections across a 1-year time horizon starting September 2023 with and without an autumn booster campaign. Initial effectiveness was predicted to be 89% and 97% against infection and hospitalization respectively based on BA.4/BA.5 antibody titers and correlates of protection. A monthly decline in protection of 1.4% and 4.8%, respectively, was assumed based on monovalent vaccine data. A decision tree was used to predict the quality-adjusted life-years (QALY) lost and costs associated with infections.

RESULTS: Considering a willingness-to-pay (WTP) threshold of £20,000/QALY, the VBP associated with an autumn 2023 booster campaign is £343/dose. Considering a WTP threshold of £30,000, the VBP increases to £476. In sensitivity analyses, excluding the post-infection costs (e.g., long COVID), reduces the VBP by 11%. Varying the hospitalization rates by +/-25% changes the VBP by +/- 6%. Varying hospitalization unit costs only impacts the VBP by 1%. Doubling the rate of waning for booster effectiveness increases the VBP by 54% because the effectiveness provided from past campaigns falls faster and an autumn 2023 booster becomes more valuable.

CONCLUSIONS: While the trajectory of COVID-19 incidence is highly uncertain, pricing the bivalent booster lower than the VBP is expected to result in a cost-effective strategy for the UK.