Universal COVID-19 vaccination cost saving unless anaphylaxis rate high

Abstract

Universal COVID-19 vaccination appears to be cost saving compared with risk-stratified vaccination unless the vaccine-related anaphylaxis rate exceeds 0.8%, according to findings of a study published in the Journal of Allergy and Clinical Immunology. A decision-tree model comparing the risks of COVID-19 infection and COVID-19 vaccine-related anaphylaxis was used to evaluate the cost effectiveness of universal vaccination (with the Pfizer-BioNTech COVID-19 vaccine [tozinameran] or Moderna COVID-19 vaccine [mRNA-1273]) versus risk-stratified vaccination (vaccine deferred in people with a self-reported history of any anaphylaxis). The primary outcomes were total hospitalisations and total deaths due to COVID-19 infection or anaphylaxis. Cost effectiveness was assessed in a population of 300 million people from a US healthcare perspective over a one-year time horizon, based on a willingness-to-pay threshold of $10 million* per death prevented. It was also assessed from a societal perspective. It was assumed that 60% of patients with COVID-19 infections were symptomatic, the hospitalisation rate in symptomatic patients was 279 per 100 000, the symptomatic case fatality rate was 2%, the risk of anaphylaxis was 0.1%, and risk stratification was 95% protective against anaphylaxis. In the base-case analysis, universal vaccination was estimated to achieve cost savings of $503 596 316 and prevent 7607 deaths compared with risk-stratification, and was therefore dominant (more effective and less costly). From a societal perspective, the estimated incremental net monetary benefit of universal vaccination was $76 569 million. Cost savings were found to be sensitive to the anaphylaxis rate. Universal vaccination dominated risk-stratified vaccination at higher COVID-19 infection rates and low rates of anaphylaxis, from both healthcare and societal perspectives. However, risk-stratification became the most cost-effective strategy when the risk of anaphylaxis was greater than 0.8%. The decision to limit routine contraindications . . . to individuals with prior anaphylaxis to a known vaccine component seems a cost-effective approach, and there is limited value present only under very particular contexts for wider exclusions, said the authors.