Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa

doi:10.1101/2021.05.07.21256852

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[Preprint]. 2021 Nov 13:2021.05.07.21256852.

doi: 10.1101/2021.05.07.21256852.

Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa

Krishna P Reddy^{1

2

3}, Kieran P Fitzmaurice¹, Justine A Scott¹, Guy Harling^{4

5

6

7

8}, Richard J Lessells⁹, Christopher Panella¹, Fatma M Shebl^{1

3}, Kenneth A Freedberg^{1

3

10

11

12}, Mark J Siedner^{1

3

4

11}

Affiliations

¹ Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
² Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
³ Harvard Medical School, Boston, MA, USA.
⁴ Africa Health Research Institute, KwaZulu-Natal, South Africa.
⁵ MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, South Africa.
⁶ School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
⁷ Institute for Global Health, University College London, London, UK.
⁸ Department of Epidemiology and Harvard Center for Population & Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁹ KwaZulu-Natal Research Innovation and Sequencing (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
¹⁰ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹¹ Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
¹² Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

PMID: 34013291
PMCID: PMC8132265
DOI: 10.1101/2021.05.07.21256852

Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa

Krishna P Reddy et al. medRxiv. 2021.

[Preprint]. 2021 Nov 13:2021.05.07.21256852.

doi: 10.1101/2021.05.07.21256852.

Authors

Affiliations

¹ Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
² Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
³ Harvard Medical School, Boston, MA, USA.
⁴ Africa Health Research Institute, KwaZulu-Natal, South Africa.
⁵ MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, South Africa.
⁶ School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
⁷ Institute for Global Health, University College London, London, UK.
⁸ Department of Epidemiology and Harvard Center for Population & Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁹ KwaZulu-Natal Research Innovation and Sequencing (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
¹⁰ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹¹ Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
¹² Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

PMID: 34013291
PMCID: PMC8132265
DOI: 10.1101/2021.05.07.21256852

Update in

Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa.
Reddy KP, Fitzmaurice KP, Scott JA, Harling G, Lessells RJ, Panella C, Shebl FM, Freedberg KA, Siedner MJ. Reddy KP, et al. Nat Commun. 2021 Oct 29;12(1):6238. doi: 10.1038/s41467-021-26557-5. Nat Commun. 2021. PMID: 34716349 Free PMC article.

Abstract

Low- and middle-income countries are implementing COVID-19 vaccination strategies in light of varying vaccine efficacies and costs, supply shortages, and resource constraints. Here, we use a microsimulation model to evaluate clinical outcomes and cost-effectiveness of a COVID-19 vaccination program in South Africa. We varied vaccination coverage, pace, acceptance, effectiveness, and cost as well as epidemic dynamics. Providing vaccines to at least 40% of the population and prioritizing vaccine rollout prevented >9 million infections and >73,000 deaths and reduced costs due to fewer hospitalizations. Model results were most sensitive to assumptions about epidemic growth and prevalence of prior immunity to SARS-CoV-2, though the vaccination program still provided high value and decreased both deaths and health care costs across a wide range of assumptions. Vaccination program implementation factors, including prompt procurement, distribution, and rollout, are likely more influential than characteristics of the vaccine itself in maximizing public health benefits and economic efficiency.

Keywords: COVID-19; South Africa; cost-effectiveness; resource allocation; vaccination.

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Conflict of interest statement

COMPETING INTERESTS RJL serves on South Africa’s Ministerial Advisory Committee on COVID-19 Vaccines (VMAC). We declare no additional competing interests.

Figures

**Figure 1.. One-way sensitivity analysis, influence of each parameter on cumulative SARS-CoV-2 infections, COVID-19 deaths, and health care costs.**
This tornado diagram demonstrates the relative influence of varying each key model parameter on clinical and economic outcomes over 360 days. This is intended to reflect the different scenarios in which a reference vaccination program (vaccine supply sufficient for 67% of South Africa’s population, pace 150,000 vaccinations per day) might be implemented. The dashed line represents the base case scenario for each parameter. Each parameter is listed on the vertical axis, and in parentheses are the base case value and, after a colon, the range examined. The number on the left of the range represents the left-most part of the corresponding bar, and the number on the right of the range represents the right-most part of the corresponding bar. The horizontal axis shows the following outcomes of a reference vaccination program: (a) cumulative SARS-CoV-2 infections; (b) cumulative COVID-19 deaths; (c) cumulative health care costs. In some analyses, the lowest or highest value of an examined parameter produced a result that fell in the middle of the displayed range of results, due to stochastic variability when the range of results was narrow.

**Figure 2.. Multi-way sensitivity analysis of vaccine effectiveness against infection and vaccination cost: incremental cost-effectiveness ratio of vaccination program compared with no vaccination.**
Each box in the 4×4 plot is colored according to the incremental cost-effectiveness ratio (ICER). The lightest color represents scenarios in which a reference vaccination program (vaccine supply sufficient for 67% of South Africa’s population, pace 150,000 vaccinations per day) is cost-saving compared with no vaccination program, meaning that it results in clinical benefit and reduces overall health care costs. The darker colors reflect increasing ICERs, whereby a reference vaccination program, compared with no vaccination program, results in both clinical benefit and higher overall health care costs. The ICER is the model-generated difference in costs divided by the difference in years-of-life between a reference vaccination program and no vaccination program. In none of these scenarios is the ICER above $2,000/year-of-life saved (YLS).

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References

1. Voysey M. et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet 397, 99–111 (2021). - PMC - PubMed
1. Polack F. P. et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 383, 2603–2615 (2020). - PMC - PubMed
1. Baden L. R. et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med 384, 403–416 (2021). - PMC - PubMed
1. Sadoff J. et al. Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19. N Engl J Med 384, 2187–2201 (2021). - PMC - PubMed
1. Torjesen I. Covid-19: Pre-purchasing vaccine—sensible or selfish? BMJ 370, m3226 (2020). - PubMed

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[1] Voysey M. et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet 397, 99–111 (2021). - PMC - PubMed

[2] Voysey M. et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet 397, 99–111 (2021). - PMC - PubMed

[3] Polack F. P. et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 383, 2603–2615 (2020). - PMC - PubMed

[4] Polack F. P. et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 383, 2603–2615 (2020). - PMC - PubMed

[5] Baden L. R. et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med 384, 403–416 (2021). - PMC - PubMed

[6] Baden L. R. et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med 384, 403–416 (2021). - PMC - PubMed

[7] Sadoff J. et al. Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19. N Engl J Med 384, 2187–2201 (2021). - PMC - PubMed

[8] Sadoff J. et al. Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19. N Engl J Med 384, 2187–2201 (2021). - PMC - PubMed

[9] Torjesen I. Covid-19: Pre-purchasing vaccine—sensible or selfish? BMJ 370, m3226 (2020). - PubMed

[10] Torjesen I. Covid-19: Pre-purchasing vaccine—sensible or selfish? BMJ 370, m3226 (2020). - PubMed

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This is a preprint.

Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa

Affiliations

Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa

Authors

Affiliations

Update in

Abstract

Conflict of interest statement

Figures

Similar articles

References

Publication types

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Miscellaneous