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. 2023 Mar 22;3(3):e0001693.
doi: 10.1371/journal.pgph.0001693. eCollection 2023.

What, how and who: Cost-effectiveness analyses of COVID-19 vaccination to inform key policies in Nigeria

Francis J Ruiz  1 , Sergio Torres-Rueda  1 , Carl A B Pearson  2   3   4 , Eleanor Bergren  1 , Chinyere Okeke  5 , Simon R Procter  3 , Andres Madriz-Montero  1 , Mark Jit  2   3 , Anna Vassall  1 , Benjamin S C Uzochukwu  5
Affiliations

What, how and who: Cost-effectiveness analyses of COVID-19 vaccination to inform key policies in Nigeria

Francis J Ruiz et al. PLOS Glob Public Health. .

Abstract

While safe and efficacious COVID-19 vaccines have achieved high coverage in high-income settings, roll-out remains slow in sub-Saharan Africa. By April 2022, Nigeria, a country of over 200 million people, had only distributed 34 million doses. To ensure the optimal use of health resources, cost-effectiveness analyses can inform key policy questions in the health technology assessment process. We carried out several cost-effectiveness analyses exploring different COVID-19 vaccination scenarios in Nigeria. In consultation with Nigerian stakeholders, we addressed three key questions: what vaccines to buy, how to deliver them and what age groups to target. We combined an epidemiological model of virus transmission parameterised with Nigeria specific data with a costing model that incorporated local resource use assumptions and prices, both for vaccine delivery as well as costs associated with care and treatment of COVID-19. Scenarios of vaccination were compared with no vaccination. Incremental cost-effectiveness ratios were estimated in terms of costs per disability-adjusted life years averted and compared to commonly used cost-effectiveness ratios. Viral vector vaccines are cost-effective (or cost saving), particularly when targeting older adults. Despite higher efficacy, vaccines employing mRNA technologies are less cost-effective due to high current dose prices. The method of delivery of vaccines makes little difference to the cost-effectiveness of the vaccine. COVID-19 vaccines can be highly effective and cost-effective (as well as cost-saving), although an important determinant of the latter is the price per dose and the age groups prioritised for vaccination. From a health system perspective, viral vector vaccines may represent most cost-effective choices for Nigeria, although this may change with price negotiation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Scenario 1: Cost-effectiveness analysis of vaccine type assuming 100% coverage for adults aged 50+ years old: Disease vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
Fig 2
Fig 2. Scenario 1: Cost-effectiveness analysis of vaccine type assuming 100% coverage for adults aged 50+ years old: Infection vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
Fig 3
Fig 3. Scenario 2: Cost-effectiveness analysis of vaccine type assuming 90% coverage for all adults aged 18+ years old: Disease vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
Fig 4
Fig 4. Scenario 2: Cost-effectiveness analysis of vaccine type assuming 90% coverage for all adults aged 18+ years old: Infection vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
Fig 5
Fig 5. Scenario 3: Cost-effectiveness analysis of vaccine delivery types assuming 100% coverage of all adults aged 50+ years old: Disease vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
Fig 6
Fig 6. Scenario 3: Cost-effectiveness analysis of vaccine delivery types assuming 100% coverage of all adults aged 50+ years old: Infection vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
Fig 7
Fig 7. Scenario 4: Cost-effectiveness analysis of vaccine delivery types assuming 25% coverage of all adults first prioritising all 50+ year olds: Disease vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
Fig 8
Fig 8. Scenario 4: Cost-effectiveness analysis of vaccine delivery types assuming 25% coverage of all adults first prioritising all 50+ year olds: Infection vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
Fig 9
Fig 9. Scenario 5: Cost-effectiveness analysis of age prioritization and target coverage for a viral vector vaccine (AstraZeneca-like): Disease vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
Fig 10
Fig 10. Scenario 5: Cost-effectiveness analysis of age prioritization and target coverage for a viral vector vaccine (AstraZeneca-like): Infection vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
Fig 11
Fig 11. Scenario 6: Cost-effectiveness analysis of age prioritization and target coverage for an mRNA vaccine (Moderna-like): Disease vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
Fig 12
Fig 12. Scenario 6: Cost-effectiveness analysis of age prioritization and target coverage for an mRNA vaccine (Moderna-like): Infection vaccine mechanism.
Applied cost-effectiveness thresholds represented by the dashed lines.
See this image and copyright information in PMC

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