Modeling the cost-effectiveness of the COVID-19 mRNA-1273 vaccine in the United States

The main objective was to estimate the potential public health impact and cost-effectiveness of an annual dose of mRNA-1273 in the United States (US) for a one-year time horizon compared with no vaccination in the mRNA-1273 licensed population (6 months-64 years with underlying medical conditions and all ≥65 years). mRNA-1273 was also compared to BNT162b2 in high-risk adults ages 18-64 years and all ≥65 years.

Analyses were conducted using a previously developed static decision-analytic model (1-year horizon) from the societal cost perspective. Vaccine effectiveness (VE) against infection and hospitalization for mRNA-1273 versus no vaccination was based on a 2024-2025 real world effectiveness study. VE estimates for mRNA-1273 versus BNT162b2 were based on systematic literature reviews and meta-analyses. Cost-effectiveness was assessed in terms of incremental cost per quality-adjusted life-year (QALY) gained and the benefit cost ratio (BCR) in the licensed target population as well as age-specific subgroups. Sensitivity and scenario analyses were performed.

Between September and August, a single dose of mRNA-1273 was estimated to yield an incremental cost per QALY gained of $23,265 compared to no vaccine. For every 1 USD of mRNA-1273 vaccine related costs, there is a return of 1.91-7.90 dollars in societal perspective cost savings and monetized health benefit gained. In the subgroup of high-risk individuals 6 months-4 years, mRNA-1273 was associated with lower costs and improved health outcomes, resulting in mRNA-1273 dominating no vaccine. Study results are sensitive to COVID-19 incidence, percentage hospitalized, post-discharge mortality, and VE assumptions. Compared to BNT162b2, given improved clinical outcomes, combined with a lower vaccine unit cost, mRNA-1273 was estimated to dominate BNT162b2.

mRNA-1273, the only licensed vaccine for those <5 years of age at high risk of severe COVID-19 related outcomes, could substantially reduce the clinical and economic burden of COVID-19 among US high-risk populations and older adults. These benefits were observed both in comparison to no vaccination and the BNT162b2 vaccine.