Incremental Net Benefit of COVID-19 Booster Vaccination: A Systematic Review and Meta-Analysis

The COVID-19 booster vaccination is recommended to maintain immunity. However, few cost-effectiveness studies of booster vaccinations exist. This meta-analysis was conducted to quantitatively pool the incremental net benefit (INB) of using COVID-19 booster vaccination.

We searched PubMed, Embase, EconLit, and the Cost-effectiveness Analysis Registry by Tufts Medical Center to identify studies from inception to December 2024. Studies were eligible if they included cost-effectiveness analyses, reporting cost per quality-adjusted life-year of COVID-19 messenger RNA or adapted booster vaccines compared with primary series or no booster vaccination. Various monetary units were converted to 2023 US dollars. The INBs were pooled across studies using a random-effects model, stratified by country income level, vaccination frequency, study perspective, and age-risk groups. The risk of bias was assessed using the Economic Evaluation Bias checklist. Heterogeneity was assessed using the I² statistic.

A total of 8 studies were identified, and 7 were included in the meta-analysis. In the general population, the pooled INB indicated annual booster vaccination was significantly cost-effective from a societal perspective (INB: $210; 95% confidence intervals [CI]: 46-373) but not significant from a payer perspective (INB: $45; 95% CI: -21 to 110). The pooled INB was not cost-effective in the high-risk group from either perspective. For the mixed-risk group, it was cost-effective only from a payer perspective.

Compared with no booster vaccination, annual messenger RNA booster vaccination was cost-effective from a societal perspective in the general population. Our findings may facilitate decision making in settings where country-specific studies are unavailable.