The Cost-Effectiveness of a COVID-19 Vaccine in a Danish Context

Covid-19 vaccines approved by the EU, UK and USA have been found to be safe and effective. The cost effectiveness of these vaccines depends upon a number of factors. The aim of this paper is to explore the cost effectiveness of a COVID-19 vaccine and to analyse how the price of the vaccine and the cost of administrating it influence its cost effectiveness.

We considered an epidemiological model developed by an expert group within 'Statens Serum Institut', which is a unit under the auspices of the Danish Ministry of Health. The model allowed us to differentiate between two population groups, those aged ≥60 years and those aged <60 years. We used the model to consider four scenarios: (i) vaccination of 25% of the total population (corresponding to approximately 1.5 million persons) but targeting vaccines towards the population aged ≥60 years, (ii) vaccination of 25% of the total population, targeting vaccines only towards the population aged <60 years, (iii) vaccination of 40% of the total population where 15% are aged <60 years and 25% are aged ≥60 years (corresponding approximately to the full Danish population aged >60 years), and (iv) 40% of the total population is vaccinated but vaccines are targeted solely towards those aged <60 years. The time horizon of the analysis was six months, and the perspective was that of the Danish healthcare sector.

The results show that inclusion of the elderly population aged ≥60 years was more cost effective than a vaccination strategy that targeted a population aged <60 years old only, when productivity losses were not included. Furthermore, the results show that an extension of the target group from the elderly population only, to also include the younger population comes with an increasing cost per life-year gained. The incremental cost-effectiveness ratio depends on the price of the vaccine, hereunder also the administration costs, and the discount rate used for the estimation of life-years or quality-adjusted life-years gained from a vaccine. Furthermore, inclusion of productivity losses in the analyses influenced the cost effectiveness of vaccination of the population aged <60 years of age.

The cost effectiveness of a COVID-19 vaccine is sensitive to whether or not productivity losses are included in the analyses. Without productivity losses, the elderly population should always be part of the target group for a COVID-19 vaccination programme. Taking productivity losses into account, at least in the case of low vaccine prices, vaccinating the younger population first can actually be cost effective.