Cost Utility of Vaccination Against COVID-19 in Brazil

The objective of this study was to evaluate the cost-utility of the Oxford, CoronaVac, and Janssen COVID-19 vaccines from the perspective of the Brazilian public health system. A total of 3 microsimulation models were constructed with individual data to evaluate the 3 vaccines. The simulation contains 7 transition states that are related to the natural history of the disease. The model with a daily cycle has a time horizon of 1 year and uses data from 289 days of the pandemic. The analysis was conducted from the perspective of the Brazilian public health system considering direct medical costs. For the model inputs, outpatient and hospital databases were used with information on treated patients stratified by age. Information on mortality was also stratified based on patients' age in the mortality database (SIM). The efficacy of vaccines to reduce the likelihood of patients becoming ill was evaluated independently for each vaccine. Information on the quality of life of patients in outpatient or hospital treatment and the sequelae resulting from the disease were extracted from the literature. The main outcome of the analysis was quality-adjusted life-years (QALYs). The vaccines showed incremental cost-utility ratios ranging from R$−23 161.3/QALY (Oxford) to R$17 757.85/QALY (CoronaVac). The older the population, the lower was the incremental cost-utility ratio. Given a willingness-to-pay threshold of R$17 586/QALY, all the vaccines were considered cost-effective in the probabilistic sensitivity analysis. The results of the analysis by age group can help in the preparation of a vaccination prioritization plan. •This is the first economic evaluation performed with COVID-19 vaccines from the perspective of the Brazilian public health system.•The analysis used real-world data on mortality and outpatient and hospital treatment, which represent the context of the first year of the pandemic in Brazil.•The study allowed for a comparison of the cost-utility ratios of 3 different vaccines used in Brazil, taking into account 3 age groups (75 years old), and demonstrating the impact of price and number of doses on the efficiency of health spending.