An unmanageable price | Weekendavisen

There can be little doubt that the economic consequences of covid-19 are extensive and that a vaccine is a very important step in being able to return to a normal everyday life. An everyday life where economic activity can be restored, and not least where we can reduce the costs and inconveniences that the corona crisis has brought with it.

Vaccinations against serious infectious diseases have been a fixed component of the Danish vaccination programs for many years. Vaccination programs have been continuously expanded as new vaccines have been developed. Even before the introduction of the measles, mumps and rubella vaccine (MMR) in 1987, an economic analysis of this was carried out, in which the cost of the vaccinations was offset against the saved costs of treating the diseases.

In a medical technology assessment in 2007, the National Board of Health found that the costs of vaccinating 12-year-old girls against human papillomavirus (HPV) were not offset by saved costs for the treatment of, among other things, cervical cancer. But it was also found that these girls, in turn, would gain a lifetime benefit as a result of avoiding cancer cases and thus avoiding deaths. The so-called cost-effectiveness for the HPV vaccine was calculated at approximately DKK 85,000 per life year gained.

Similarly, calculations have been made of these cost-effectiveness ratios for the introduction of influenza vaccination in persons aged 65 and over. It was calculated at approximately 45,000-60,000 kroner per year of life gained (in 2000 prices).

Common to these analyzes is that the costs for purchasing the vaccines and for administration, including fees for the general practitioners who have to perform the vaccinations, were set in relation to saved costs in the health care system as a result of, among other things, avoided hospital admissions, whereas costs outside the health care system not included.

In the Danish context, health economic analyzes of screening programs against cancer are also included. Here, the cost-effectiveness of, for example, breast cancer screening and screening for cervical cancer is in the range of 76,000-157,000 kroner per life year gained.

Years of life gained

In that light, it is interesting to examine how a health economic analysis of a vaccine against covid-19 will turn out. In a research project that is available in the form of a working paper, we have done the experiment.

The purpose of the project is to assess whether the cost of vaccinating is commensurate with the saved costs and the benefits that are expected to be in the form of avoided deaths with years of life gained as a result. In the same way as previous analyzes of vaccines, we have limited ourselves to only the saved hospital admissions, even though we are aware that there are many other derived costs.

There are, of course, many uncertainties associated with such an analysis. We first learn about the course of the epidemic while we are in the middle of it. In addition, although the prices of the vaccines have been revealed, the total cost of carrying out the vaccinations will depend on how they are organized.

The analysis is based on the mathematical model that the Statens Serum Institut (SSI) developed to describe the development of the epidemic. We use it to calculate how many admissions can be avoided in different vaccination scenarios. The model can distinguish between vaccination of persons over and under 60 years of age.

We also calculate how many life years you will be able to gain on the basis of statistics on the expected remaining life.

Our calculations show that the cost-effectiveness of vaccinating all Danes aged 60 and over will be between approximately 71,000 and approximately 190,000 kroner per year of life gained. The estimate is particularly dependent on the total cost of vaccinations. We have let them vary between 300 and 500 kroner.

By expanding the number of vaccinations to include, in addition to everyone aged 60 and older, also initially vaccinating 900,000 people under the age of 60, the cost effect increases to between approximately 160,000 and approximately 540,000 kroner per life year gained. It is again the cost of the vaccination, but also the weighting of the lifetime gains over time, that is the reason for the wide range.

A similar result has been found in a US health economic analysis of a vaccine. This study, which has also not been published yet, but which is available in manuscript form, similarly shows that the cost per gained quality-adjusted life years increases with the gradual involvement of population groups with lower and lower risk of serious disease courses.

Lower prices

Interesting in our analysis is that for lower prices for the covid-19 vaccine, it is assessed that the vaccine may have a cost-effectiveness ratio that is lower or on a par with other vaccines in the Danish vaccination program and screenings.

In the long run, it is expected that the price of the vaccine will fall. The vaccines that are still awaiting approval by the pharmaceutical authorities are expected to be cheaper than the vaccines that have just been approved and put into use. By including them in Denmark, the cost-effectiveness will be reduced.

Right now, Denmark, together with the rest of the world, is facing the need to deal with the acute infection situation. Our analysis shows that the cost of covid-19 vaccine does not completely outweigh the costs of hospitalizations, coronary tests and medical follow-up of infected people, but is in reasonable proportion to other gains in terms of avoided deaths and resulting life years from the healthcare sector perspective.

In addition to the health economic costs, the Covid-19 pandemic also entails large losses of productivity in society, as well as other economic and social consequences of the restrictions. In the past, no economic analyzes have been made of treatments for diseases that have such far-reaching consequences as covid-19.

The Cost-Effectiveness of a COVID-19 Vaccine in a Danish Context (26. januar 2021). Discussion Papers on Business and Economics, University of Southern Denmark, 2/2021.

Blue Book

Kristian Debrabant is an associate professor at the Department of Mathematics and Computer Science at the University of Southern Denmark. Lone Grønbæk is an associate professor and head of department at the Department of Business Management and Economics at the University of Southern Denmark. Christian Kronborg is an associate professor and deputy head of department for education and head of studies at
Department of Management and Economics.

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