The potential public health and economic value of a hypothetical COVID-19 vaccine in the United States: Use of cost-effectiveness modeling to inform vaccination prioritization

Background: Researchers are working at unprecedented speed to develop a SARS-CoV-2 vaccine. We aimed to assess the value of a hypothetical vaccine and its potential public health impact when prioritization is required due to supply constraints. Methods: A Markov cohort model was used to compare COVID-19 related direct medical costs and deaths in the United States (US), with versus without implementation of a 60% efficacious vaccine. To prioritize the vaccine under constrained supply, the population was divided into tiers based on age; risk and age; and occupation and age; and outcomes were compared across one year under various supply assumptions. For each prioritization strategy, the incremental cost per quality-adjusted life-year (QALY) gained versus no vaccine was calculated overall and by tier. Findings: Overall, the cost per QALY gained for all vaccination strategies was $8,200 versus no vaccination. For the tiers at highest risk of complications from COVID-19, vaccination was cost-saving compared to no vaccination. The cost per QALY gained increased as the risk of hospitalization and death within each tier decreased. Under the most optimistic supply scenario and the most efficient prioritization scenario, the vaccine may prevent 32% of expected deaths. As supply becomes more constrained, prioritization is required to optimize the prevention of deaths. Interpretation: A COVID-19 vaccine is predicted to be good value for money (cost per QALY gained