key: cord-0768060-fltxiqkv authors: Jiang, Yawen; Cai, Dan; Shi, Si title: Economic evaluations of inactivated COVID-19 vaccines in six Western Pacific and South East Asian countries and regions: A modeling study date: 2021-12-10 journal: Infect Dis Model DOI: 10.1016/j.idm.2021.12.002 sha: 17a6a4dce17c042a5d0de1f1751b5cdd05ca5948 doc_id: 768060 cord_uid: fltxiqkv OBJECTIVE: The present study aimed to document the economic profiles of inactivated COVID-19 vaccines in Hong Kong, Indonesia, mainland China, Philippines, Singapore, and Thailand, the evidence on which is currently absent. METHODS: Decision tree models were developed to assess the cost-effectiveness of two doses of inactivated COVID-19 vaccines at a population vaccination rate of 50% in the base case, which was an estimate of feasible vaccination coverage according to previous studies. Epidemiological, mortality, cost, and health state utility information were sourced from the literature. Vaccine efficacy against COVID-19 cases by severity were estimated using meta-analyses of publicly accessible phase 3 trial results of inactivated vaccines. The health outcomes were quantified as quality-adjusted life years (QALYs) and compared across the vaccination and no vaccination strategies. In scenario analyses, incidence and vaccination rates were changed semi-continuously over spectrums, the results of which were presented as contour lines informing the efficiency frontiers of vaccination strategies. One-way and probabilistic sensitivity analyses were also conducted. RESULTS: The vaccination strategy was dominant in all jurisdictions in the base case by producing 105.18, 98.15, 99.70, 60.48, 112.00, and 103.47 QALYs while saving US$40.26 million, US$5.26 million, US$7.60 million, US$5.91 million, US$21.33 million, and US$7.18 million in Hong Kong SAR, Indonesia, mainland China, Philippines, Singapore, and Thailand per every 100,000 vaccinated individuals, respectively. Results were robust in alternative model specifications. CONCLUSIONS: Inactivated COVID-19 vaccines may be cost-saving options in Hong Kong SAR, Indonesia, mainland China, Philippines, Singapore, and Thailand. Mass vaccination programs using inactivated COVID-19 vaccines should be considered in these jurisdictions. As of the 1 st week of Oct 2021, over 235 million cumulative COVID-19 cases have 54 been reported globally [1] . With the pandemic persisting into another year, many 55 countries and regions sweated to roll out vaccination plans, which were made possible 56 by encouraging outputs of unprecedented commitments to developing vaccines against 57 SARS-Cov-2. In fact, COVID vaccination is considered to have a pivotal role in many 58 pandemic exit strategies that are being considered [2-4]. By Oct 8, 2021, twenty-four 59 vaccines have seen full or conditional approvals in at least one country, followed by six 60 competitors that have been authorized for emergency or limited use [5] . These vaccines 61 were developed using different technologies including genetic vaccines, viral vector 62 vaccines, and inactivated vaccines [5, 6] . Whereas other technologies such as protein-63 based vaccinology is also being employed, the corresponding products have not yet 64 taken the leading positions in clinical development. Due to the different biological 2-8 °C, the corresponding shelf life is only 1/5 of that of the inactivated vaccines [6, 9] . 75 The lack of robust ultracold chain infrastructures may cause disproportionate damage 76 to vaccine accessibility in LMICs, exacerbating healthcare inequality [10] . As such, least one country or region globally, two of which were eligible for the present analysis 114 because they were accessible in two or more target jurisdictions of the present analysis 115 [5] . Namely, the two vaccines are HB02 (also known as BBIBP-CorV) and CoronaVac, 116 both of which are two-dose regimens injected 3-8 weeks apart [15, 16] S1 ). It was assumed that the first dose allowed half of the maximum efficacy during the 140 J o u r n a l P r e -p r o o f 4-week interval. Finally, the VE against mild and moderate cases was assumed to be 141 the same as that for symptomatic infections since severe cases accounted for a miniscule 142 proportion of all symptomatic cases in the trials [19, 20] . In scenario analyses that are 143 detailed in a later section, the profile of each type of inactivated vaccine was used. The 144 efficacy estimates of any infections, symptomatic infections, mild and moderate cases, 145 and severe cases were applied to the corresponding chance nodes in the decision tree. In the vaccination strategy, 50% of individuals received the first shot on day 1, In the no vaccination strategy, individuals were confronted with the background 177 attack rate of the pandemic without any artificial immunization, but otherwise followed 178 the same set of clinical courses once infected. To account for heterogeneity in health utility, potential QALY loss related to 180 mortality, and productivity loss, we stratified the model by three age groups including 181 <20 years, 20-59 years, and ≥60 years, the distributions of which were obtained from The accrual of productivity loss was based on the human capital costs approach, in 269 which daily labor compensation rate was first multiplied by the labor participation rate group of ≥60 years and older was not considered, whereas the age group of <20 years 274 only accrued productivity loss over the period beyond 16 years old. All input values related to costs are listed in Table 1 CoronaVac against symptomatic cases using a second meta-analysis in the current study. The pooled estimate of VE against symptomatic cases was 67.9% (Fig S2) . Also, In a set of exploratory analyses, the incidence rate and the vaccination rate were 331 each toggled over a continuum. The output of the analyses were contour graphs 332 showing the frontier of incidence-vaccination combinations over which the vaccination 333 strategies were cost-effective at the once the GDP per capita threshold. To examine the impacts of parameter uncertainty, the inputs were varied upward 335 and downward in one-way sensitivity analyses (OWSAs). Among these, most Table 1 . Table 2 . Table S2 . For all countries and regions, the 377 strategy of vaccinating everyone was the optimal strategy whereas other strategies were 378 dominated. When the incidence and vaccination rates were varied semi-continuously, 380 vaccinating the population generated NMB when the incidence rate was above In the present study, decision-tree models were used to analyze the cost- The results of the present study should be interpreted with several caveats. First, 444 the present study relied on several assumptions for input data as with most modeling 445 exercises. 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