Cost-effectiveness analysis of BNT162b2 COVID-19 booster vaccination in the United States

Objectives: To evaluate the cost-effectiveness of a booster strategy in the United States. Methods: We developed a decision-analytic Markov model of COVID-19 to evaluate the cost-effectiveness of a booster strategy of the Pfizer-BioNTech BNT162b2 (administered 6 months after the second dose) among older adults from a healthcare system perspective. Results: Compared with 2 doses of BNT162b2 without a booster, the booster strategy in a 100,0 00 cohort of older adults would incur an additional cost of $3.4 million in vaccination cost but save $6.7 million in direct medical cost and gain 3.7 quality-adjusted life-years in 180 days. This corresponds to a benefit-cost ratio of 1.95 and a net monetary benefit of $3.4 million. Probabilistic sensitivity analysis indicates that a booster strategy has a high chance (67%) of being cost-effective. Notably, the cost-effectiveness of the booster strategy is highly sensitive to the population incidence of COVID-19, with a cost-effectiveness threshold of 8.1/100,0 00 person-day. If vaccine efficacies reduce by 10%, 30%, and 50%, this threshold will increase to 9.7/100,00 0, 13.9/100,0 00, and 21.9/100,0 00 person-day, respectively. Conclusion: Offering the BNT162b2 booster to older adults aged >= 65 years in the United States is likely to be cost-effective. Less efficacious vaccines and boosters may still be cost-effective in settings of high SARS-CoV-2 transmission. (C) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Automated summary

The cost-effectiveness of a booster strategy for COVID-19 vaccination in older adults in the United States was evaluated. The results show that offering a booster dose of the Pfizer-BioNTech vaccine to older adults can result in cost savings in direct medical costs and improve quality-adjusted life-years. The cost-effectiveness of the booster strategy is sensitive to the population incidence of COVID-19 and vaccine efficacies.