health impact and cost effectiveness of covid 19 vaccination in sindh province pakistan CORD-Papers-2022-06-02 (Version 1)

Title: Health impact and cost-effectiveness of COVID-19 vaccination in Sindh Province Pakistan
Abstract: Background Multiple COVID-19 vaccines appear to be safe and efficacious but only high-income countries have the resources to procure sufficient vaccine doses for most of their eligible populations. The World Health Organization has published guidelines for vaccine prioritisation but most vaccine impact projections have focused on high-income countries and few incorporate economic considerations. To address this evidence gap we projected the health and economic impact of different vaccination scenarios in Sindh province Pakistan (population: 48 million). Methods We fitted a compartmental transmission model to COVID-19 cases and deaths in Sindh from 30 April to 15 September 2020 using varying assumptions about the timing of the first case and the duration of infection-induced immunity. We then projected cases and deaths over 10 years under different vaccine scenarios. Finally we combined these projections with a detailed economic model to estimate incremental costs (from healthcare and partial societal perspectives) disability adjusted life years (DALYs) and cost-effectiveness for each scenario. Findings A one-year vaccination campaign using an infection-blocking vaccine at $3/dose with 70% efficacy and 2.5 year duration of protection is projected to avert around 0.93 (95% Credible Interval: 0.91 1.0) million cases 7.3 (95% CrI: 7.2 7.4) thousand deaths and 85.1 (95% CrI: 84.6 86.8) thousand DALYs and be net cost saving from the health system perspective. However paying a high price for vaccination ($10/dose) may not be cost-effective. Vaccinating the older (65+) population first would prevent slightly more deaths and a similar number of cases as vaccinating everyone aged 15+ at the same time at similar cost-effectiveness. Interpretation COVID-19 vaccination can have a considerable health impact and is likely to be cost-effective if more optimistic vaccine scenarios apply. Preventing severe disease is an important contributor to this impact but the advantage of focusing initially on older high-risk populations may be smaller in generally younger populations where many people have already been infected typical of many low- and -middle income countries as long as vaccination gives good protection against infection as well as disease.
Published: 2021-02-25
DOI: 10.1101/2021.02.24.21252338
DOI_URL: http://doi.org/10.1101/2021.02.24.21252338
Author Name: Pearson C A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/pearson_c_a
Author Name: Bozzani F
Author link: https://covid19-data.nist.gov/pid/rest/local/author/bozzani_f
Author Name: Procter S R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/procter_s_r
Author Name: Davies N G
Author link: https://covid19-data.nist.gov/pid/rest/local/author/davies_n_g
Author Name: Huda M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/huda_m
Author Name: Jensen H T
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jensen_h_t
Author Name: Keogh Brown M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/keogh_brown_m
Author Name: Khalid M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/khalid_m
Author Name: Sweeney S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sweeney_s
Author Name: Torres Rueda S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/torres_rueda_s
Author Name: CHiL COVID Working Group
Author link: https://covid19-data.nist.gov/pid/rest/local/author/chil_covid_working_group
Author Name: CMMID COVID Working Group
Author link: https://covid19-data.nist.gov/pid/rest/local/author/cmmid_covid_working_group
Author Name: Eggo R M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/eggo_r_m
Author Name: Vassall A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/vassall_a
Author Name: Jit M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jit_m
sha: c3d979565fea4acec7f1d01c9435a28f2dafaf27
license: medrxiv
source_x: MedRxiv; WHO
source_x_url: https://www.who.int/
url: https://doi.org/10.1101/2021.02.24.21252338 http://medrxiv.org/cgi/content/short/2021.02.24.21252338v1?rss=1
has_full_text: TRUE
Keywords Extracted from Text Content: bodies medRxiv preprint LMICs COVID-19 V life-tables WorldPop sub-compartments re-introductions poliovirus campaign lines medRxiv 126.1 MC_PC_19065 -Covid 19 Coronavirus Disease 2019 Gavi Crl COVID-19 vaccines R ecovered people EPI UK MRC https://github.com/cmmid/vaxco Coronavirus SI Figure S3 pre-May https://doi.org/10.1101/2021.02.24.21252338 doi SARS-CoV-2 virus medRxiv preprint pre-ordering COVID-19 patients line UNICEF SI Table S7 Tracker NIHR200929 Vaccine Programme'' section SI Figures SY-SZ COVID-19 vaccine UK GDP premature-death 3/dose solid line SI section 6 COVID-19 Vaccines matrix SARS-CoV-2 human NPIs freight charges COVID-19 SEIRS+V ( S usceptible, Serum medRxiv preprint Figure 1 Vaccine E xposed, CEPI PKR SI sections 6-7 Ulla COVID-19 vaccine
Extracted Text Content in Record: First 5000 Characters:medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. relevant to our study. Four of these studies exclusively focused on low-or middle-income countries (India, China, Mexico), while 3 multi-country analyses also included low-or middle-income settings. The majority of studies overall conclude that targeting COVID-19 vaccination to older age groups is the preferred strategy to minimise mortality, particularly when vaccine supplies are constrained, while other age-or occupational risk groups should be priorities when vaccine availability increases or when other policy objectives are pursued. Only three studies considered economic outcomes, all of them comparing the costs of vaccination to the costs of other non-pharmaceutical interventions and concluding that both are necessary to reduce infections and maximise economic benefit. Our study provides the first combined epidemiological and economic analysis of COVID-19 vaccination based on real-world disease and programmatic information in a low-or middle-income country. Our findings suggest that vaccination in this setting is highly cost-effective, and even cost saving, as long as the vaccine is reasonably priced and efficacy is high. Unlike studies in high-income settings, we also found that vaccination programmes targeting all adults may have similar impact to those initially targeted at older populations, likely reflecting the higher previous infection rates and different demography in these settings. LMICs and international bodies providing guidance for LMICs need to consider evidence specific to these settings when making recommendations about COVID-19 vaccination. Further data and model-based analyses in such settings are urgently needed in order to ensure that vaccination decisions are appropriate to their contexts. Multiple COVID-19 vaccines appear to be safe and efficacious, but only high-income countries have the resources to procure sufficient vaccine doses for most of their eligible populations. The World Health Organization has published guidelines for vaccine prioritisation, but most vaccine impact projections have focused on high-income countries, and few incorporate economic considerations. To address this evidence gap, we projected the health and economic impact of different vaccination scenarios in Sindh province, Pakistan (population: 48 million). We fitted a compartmental transmission model to COVID-19 cases and deaths in Sindh from 30 April to 15 September 2020 using varying assumptions about the timing of the first case and the duration of infection-induced immunity. We then projected cases and deaths over 10 years under different vaccine scenarios. Finally, we combined these projections with a detailed economic model to estimate incremental costs (from healthcare and partial societal perspectives), disability adjusted life years (DALYs), and cost-effectiveness for each scenario. A one-year vaccination campaign using an infection-blocking vaccine at $3/dose with 70% efficacy and 2.5 year duration of protection is projected to avert around 0.93 (95% Credible Interval: 0.91, 1.0) million cases, 7.3 (95% CrI: 7.2, 7.4) thousand deaths and 85.1 (95% CrI: 84.6, 86.8) thousand DALYs, and be net cost saving from the health system perspective. However, paying a high price for vaccination ($10/dose) may not be cost-effective. Vaccinating the older (65+) population first would prevent slightly more deaths and a similar number of cases as vaccinating everyone aged 15+ at the same time, at similar cost-effectiveness. Interpretation COVID-19 vaccination can have a considerable health impact, and is likely to be cost-effective if more optimistic vaccine scenarios apply. Preventing severe disease is an important contributor to this impact, but the advantage of focusing initially on older, high-risk populations may be smaller in generally younger populations where many people have already been infected, typical of many low-and -middle income countries, as long as vaccination gives good protection against infection as well as disease. The Coronavirus Disease 2019 (COVID- 19) pandemic has resulted in over 50 million cases and nearly 2 million deaths in 2020, with cases in nearly every country (1) . To reduce transmission of the causal SARS-CoV-2 virus, many countries have imposed physical distancing measures such as closure of schools and workplaces, and restrictions on public gatherings (2) . Such measures often incur socioeconomic costs that are not indefinitely sustainable, particularly in resource poor settings (3) , and, when these measures are lifted, transmission has readily resumed in most places (4) . Vaccination may provide a durable option to protect individuals. If a vaccine also reduces transmission (e.g., by preventing infection or limiting infectiousness of disease), even unvaccinated individuals would have reduced infection risk. As of January 20
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