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

Author

Listed:
  • Francis J Ruiz
  • Sergio Torres-Rueda
  • Carl A B Pearson
  • Eleanor Bergren
  • Chinyere Okeke
  • Simon R Procter
  • Andres Madriz-Montero
  • Mark Jit
  • Anna Vassall
  • Benjamin S C Uzochukwu

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.

Suggested Citation

  • Francis J Ruiz & Sergio Torres-Rueda & Carl A B Pearson & Eleanor Bergren & Chinyere Okeke & Simon R Procter & Andres Madriz-Montero & Mark Jit & Anna Vassall & Benjamin S C Uzochukwu, 2023. "What, how and who: Cost-effectiveness analyses of COVID-19 vaccination to inform key policies in Nigeria," PLOS Global Public Health, Public Library of Science, vol. 3(3), pages 1-19, March.
    • Handle: RePEc:plo:pgph00:0001693
    DOI: 10.1371/journal.pgph.0001693
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    References listed on IDEAS

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    1. Jessica Ochalek & James Lomas & Karl Claxton, 2015. "Cost per DALY averted thresholds for low- and middle-income countries: evidence from cross country data," Working Papers 122cherp, Centre for Health Economics, University of York.
    2. Carl A B Pearson & Fiammetta Bozzani & Simon R Procter & Nicholas G Davies & Maryam Huda & Henning Tarp Jensen & Marcus Keogh-Brown & Muhammad Khalid & Sedona Sweeney & Sergio Torres-Rueda & CHiL COVI, 2021. "COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness," PLOS Medicine, Public Library of Science, vol. 18(10), pages 1-19, October.
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