Objective The coronavirus disease 2019 (COVID-19) pandemic has imposed significant costs on economies. Safe and effective vaccines are a key tool to control the pandemic; however, vaccination programs can be costly. Are the benefits they bestow worth the costs they incur? The relative value of COVID-19 vaccines has not been widely assessed. In this study, a cost-effectiveness analysis was performed to provide evidence of the economic value of vaccines in Hong Kong. Method We developed a Markov model of COVID-19 infections using a susceptible–infected–recovered structure over a 1-year time horizon from a Hong Kong healthcare sector perspective to measure resource utilization, economic burden, and disease outcomes. The model consisted of two arms: do nothing and implement a vaccination program. We assessed effectiveness using units of quality-adjusted life years (QALYs) to measure the incremental cost-effectiveness at a HKD 1,000,000/QALY threshold. Results The vaccination program, which has reached approximately 72% of the population of Hong Kong with two vaccine doses, was found to have a cost of HKD 22,339,700 per QALY gained from February 2021 to February 2022. At a willingness-to-pay threshold, the vaccination program was not cost-effective in the context of the low prevalence of COVID-19 cases before the Omicron wave. However, the cost-effectiveness of a COVID-19 vaccine is sensitive to the infection rate. Hong Kong is now experiencing the fifth wave of the Omicron. It is estimated that the ICER of the vaccination program from February 2022 to February 2023 was HKD 310,094. The vaccination program in Hong Kong was cost-effective in the context of the Omicron. Conclusions Vaccination programs incur a large economic burden, and we therefore need to acknowledge their limitations in the short term. This will help relevant departments implement vaccination programs. From a longer-term perspective, the vaccination program will show great cost-effectiveness once infection rates are high in a regional outbreak. Compared with other age groups, it is suggested that the elderly population should be prioritized to improve the vaccine coverage rate.

No abstract

Background: Although China began implementing medical reforms in 2009 aimed at fair allocation of the regional distribution of doctors, little is known of their impact. This study analyzed the geographic distribution of doctors from 2002 to 2017. Methods: This study calculated the Gini coefficient and Theil index among doctors in the eastern, central, and western regions (Category 1) of China, and in urban and rural areas (Category 2). The statistical significance of fairness changes was analyzed using the Mann–Whitney U test. Results: The annual growth rates of the number of doctors for the periods from 2002 to 2009 and 2010 to 2017 were 2.38% and 4.44%. The Gini coefficients among Category 1 were lower than those in Category 2, and statistically decreased after the medical reforms (P < 0.01) but continued to increase in Category 2 (P = 0.463). In 2017, the Theil decomposition result of Category 1 was 74.33% for the between-group, and in Category 2, it was 95.22% for the within-group. Conclusions: The fairness among the regional distribution of doctors in Category 1 is now at a high level and is better than that before the reforms. While the fairness in Category 2 is worse than that before the reforms, it causes moderate inequality and is continually decreasing. Overall unfairness was found to be derived from the between-group.

ObjectivesThis paper presents a geographic information system (GIS)-based proximal area method and gravity method for identifying areas with physician shortages. The innovation of this paper is that it uses the appropriate methods to discover each type of health resource and then integrates all these methods to assess spatial access to health resources using population distribution data. In this way, spatial access to health resources for an entire city can be visualized in one neat package, which can help health policy makers quickly comprehend realistic distributions of health resources at a macro level.MethodsFirst, classify health resources according to the trade areas of the patients they serve. Second, apply an appropriate method to each different type of health resource to measure spatial access to those resources. Third, integrate all types of access using population distribution data.ResultsIn case study of Shanghai with the fusion method, areas with physician shortages are located primarily in suburban districts, especially in district junction areas. The result suggests that the government of Shanghai should pay more attention to these areas by investing in new or relocating existing health resources.ConclusionThe fusion method is demonstrated to be more accurate and practicable than using a single method to assess spatial access to health resources.