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

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

doi:10.1371/journal.pgph.0001693

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

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

Authors

Affiliations

¹ Department of Global Health & Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
² Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
³ Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
⁴ South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, Republic of South Africa.
⁵ Department of Community Medicine, University of Nigeria Nsukka, Enugu Campus, Nsukka, Nigeria.

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.

Copyright: © 2023 Ruiz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The contributions of ST-R, FR, CABP, AMM, BSC (Uzochukwu), CO, EB, SRP, MJ and AV are supported by the International Decision Support Initiative, which is funded by the Bill and Melinda Gates Foundation (OPP1202541). MJ has received funding from the European Union’s Horizon 2020 research and innovation programme - project EpiPose (Grant agreement number 101003688); MJ has also received funding from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Modelling and Health Economics at Imperial College and LSHTM in partnership with UKHSA. The European Commission is not responsible for any use that may be made of the information it contains. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or UKHSA. The contributions of CABP is supported by the World Health Organization. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funders supported researcher time and other resources (such as computer equipment) needed for completion of the study.