OBJECTIVES: To provide evidence for medical pricing of COVID-19 vaccination by analyzing the cost-effectiveness of different types of COVID-19 vaccines (namely, inactivated, adenovirus, recombinant protein, and mRNA vaccines) using RCT and real-world effectiveness data.

METHODS: Firstly, cost-effectiveness analysis of a whole inoculation of four kinds of COVID-19 vaccines was conducted, using the efficacy and effectiveness data driven from multi-center random clinical trials (RCT) or meta-analyses, while the cost data was collected from real-world. Secondly, the incremental cost-effectiveness ratio (ICER) of a whole inoculation in avoiding COVID-19 related infection, hospitalization, ICU admission, and death were calculated and compared, and then the most cost-effective vaccine was set as the comparator. Finally, prices of vaccines were adjusted to reach an equal ICER with the comparator vaccine.

RESULTS: When medical insurance purchasing price of inactivated vaccine per dose was at 20.00 CNY, the cost of a whole inoculation should be capped at 62.34 CNY, including vaccine cost, transportation cost, storage cost and injection fee; therefore, the net price per dose of inactivated, adenovirus, recombinant protein, and mRNA vaccines were 18.80, 48.10, 9.03, and 17.51 CNY, respectively. Vaccination was cost-saving, and among them, mRNA vaccine was the most cost-saving strategy. Under the comprehensive consideration of the effects in avoiding COVID-19 related infection, hospitalization, ICU admission, and death, the prices of a whole inoculation of four kinds of vaccines should be reduced to 52.80, 48.92, 53.35, and 62.34 CNY, and the price per dose should be at 14.32, 35.49, 6.22, and 17.51 CNY, respectively.

CONCLUSIONS: COVID-19 vaccines are cost-saving in preventing COVID-19 related infection, hospitalization, ICU admission, and avoiding death from a societal perspective, regardless of the type. Medical insurance reimbursement price of COVID-19 vaccines can be set and adjusted based on economic evaluation using RCT and real-world effectiveness evidence.