Click to Enlarge: The base case incremental cost-effectiveness ratio was $115 588. Critical illness indicates intensive care unit (ICU) stays and deaths. QALY indicates quality-adjusted life-year; VE, vaccine effectiveness.
a. Lower input was equal to the base case.
Source: JAMA Network Open.
ANN ARBOR, MI — One of the complaints about widespread vaccinations during the COVID-19 pandemic is that the effort was a waste of time and money because so many Americans were at relatively low risk of having severe outcomes.
A new study recently made a different case, however. “As the nation gears up for the rollout of an updated COVID-19 vaccine, a new study shows the economic benefits of continued broad vaccination in adults,” wrote the University of Michigan authors.
They maintained that the United States would ultimately save more money than it would spend vaccinating every person over age 65 with a single dose of an updated mRNA vaccine against coronavirus.
At the VA, since the onset of the COVID-19 pandemic until the 2024-25 influenza season, hospitalization and mortality rates associated with COVID-19 have consistently been higher than those for seasonal influenza, according to other recent research.
The report in JAMA Network Open detailed the cost of long-term illness and lost productivity in this age group, many of whom still work full-time or part-time.1
The study team added that the investment remains favorable in middle-age adults from 50 to 64 years old, and that vaccinating healthy young adults age 18 to 49 would fall within accepted limits for cost-effectiveness under certain conditions.
“We show that a single dose of 2023-2024 mRNA COVID-19 vaccine averted substantial illness and death across age groups and that this led to economically attractive results for both of the older age groups across wide variations in the parameters of the model,” said lead author Lisa Prosser, PhD. “However, we also find that a second dose in non-immunocompromised adults under age 64 was not economically favorable, though a second dose in adults over age 65 was.”
The researchers sought to determine the cost-effectiveness of vaccination with a 2023-2024 COVID-19 mRNA vaccine in adults age 18 years or older compared with no updated vaccination. Their decision analytic modeling study in a simulated cohort projected that cost-effectiveness for a 2023-2024 COVID-19 mRNA vaccine using base case assumptions was cost saving for individuals older than 65 years, $25,787 per quality-adjusted life-year gained for those aged 50 to 64 years and $115,588 per quality-adjusted life-year gained for those aged 18 to 49 years. “Results were robust to changes in parameter inputs for the older age groups but sensitive to inputs for the younger age group,” the researchers wrote.
They said their findings suggested that vaccination is economically attractive in general for older adults but only under certain conditions for younger adults.
The study noted that evidence is needed on the economic favorability of a 2023-2024 COVID-19 vaccination program to support policy decisions on recommendations for COVID-19 vaccination.
The decision analytic modeling study used a simulation model to compare outcomes for hypothetical cohorts of vaccinated and unvaccinated, immunocompetent adults stratified by age—18-49 years, 50–64 years and ≥65 years.
Parameters were drawn from primary and published data to represent characteristics of the U.S. adult population. The initial study focused on vaccination with a 2023-2024 mRNA vaccine against COVID-19–associated illness compared with no updated vaccination (with a 2023-2024 vaccine) using a 1-year analytic time frame. A second-phase analysis also considered an intervention strategy of vaccination with an additional dose of 2023-2024 COVID-19 mRNA vaccine.
Those results indicated that vaccination averted substantial numbers of cases, hospitalizations, intensive-care unit stays and deaths across age groups. They reported that sensitivity analyses indicated that the results were most sensitive to the cost per vaccine dose, vaccine effectiveness and probability of hospitalization. In the second-phase analyses, an additional dose strategy was only economically favorable in higher-risk scenarios for individuals aged 65 years or older.
“In this modeling study, economic favorability of COVID-19 vaccination varied by age. Cost-effectiveness results for individuals in the 2 older age groups were favorable and generally robust to changes in parameter inputs, while results for the younger age group were sensitive to parameter input changes,” the authors concluded. “As the evidence base for COVID-19 vaccination and burden of illness evolves, it may be important to continue to update and revise the economic evaluation of vaccination.”
The researchers noted that the Advisory Committee on Immunization Practices considered their results in its decision to recommend vaccination with the 2023 to 2024 COVID-19 mRNA vaccines.
The number of cases of COVID-19, of any severity, which could be prevented through broad vaccination was about the same for all three age groups, between 7,600 and 8,900 for every 100,000 adults vaccinated, according to the study.
Prosser suggested that declining COVID-19 hospitalization rates might contribute to less favorable economic outcomes in future analyses.
- LA, Wallace M, Rose AM, et al. Cost-Effectiveness of 2023-2024 COVID-19 Vaccination in US Adults. JAMA Netw Open. 2025;8(8):e2523688. doi:10.1001/jamanetworkopen.2025.23688