The potential health and economic value of SARS-CoV-2 vaccination alongside physical distancing in the UK: transmission model-based future scenario analysis and economic evaluation

Abstract

Background In response to the coronavirus disease 2019 (COVID-19), the UK adopted mandatory physical distancing measures in March 2020. Vaccines against the newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may become available as early as late 2020. We explored the health and economic value of introducing SARS-CoV-2 immunisation alongside physical distancing scenarios in the UK. Methods We used an age-structured dynamic-transmission and economic model to explore different scenarios of immunisation programmes over ten years. Assuming vaccines are effective in 5-64 year olds, we compared vaccinating 90% of individuals in this age group to no vaccination. We assumed either vaccine effectiveness of 25% and 1-year protection and 90% re-vaccinated annually, or 75% vaccine effectiveness and 10-year protection and 10% re-vaccinated annually. Natural immunity was assumed to last 45 weeks in the base case. We also explored the additional impact of physical distancing. We considered benefits from disease prevented in terms of quality-adjusted life-years (QALYs), and costs to the healthcare payer versus the national economy. We discounted at 3.5% annually and monetised health impact at 20,000 per QALY to obtain the net monetary value, which we explored in sensitivity analyses. Findings Without vaccination and physical distancing, we estimated 147.9 million COVID-19 cases (95% uncertainty interval: 48.5 million, 198.7 million) and 2.8 million (770,000, 4.2 million) deaths in the UK over ten years. Vaccination with 75% vaccine effectiveness and 10-year protection may stop community transmission entirely for several years, whereas SARS-CoV-2 becomes endemic without highly effective vaccines. Introducing vaccination compared to no vaccination leads to economic gains (positive net monetary value) of 0.37 billion to +1.33 billion across all physical distancing and vaccine effectiveness scenarios from the healthcare perspective, but net monetary values of physical distancing scenarios may be negative from societal perspective if the daily national economy losses are persistent and large. Interpretation Our model findings highlight the substantial health and economic value of introducing SARS-CoV-2 vaccination. Given uncertainty around both characteristics of the eventually licensed vaccines and long-term COVID-19 epidemiology, our study provides early insights about possible future scenarios in a post-vaccination era from an economic and epidemiological perspective.

Simplified Mathematical Modelling of Uncertainty: Cost-Effectiveness of COVID-19 Vaccines in Spain

“…If SARS-CoV-2 behaves as A(H1N1) influenza with periodic outbreaks-something not improbable as both are RNA viruses-even with measures of social distancing and periodic lockdowns (each time less popular among citizens), Spain should expect, in the next 10 years, between 7 and 12 million of confirmed cases, and over 400,000 deaths (at decreasing ratio of about 45,000 per year), a value consistent with estimations in the UK by Sandmann et al [64]. Following this reference-assuming 75% efficacy, 10 years protection and 10% of revaccination, discount rate of 3.5% and monetized health impact at £20,000 (€22,000)-vaccination (plus physical distancing) versus no vaccination will represent between €6.11 and €21.95 million economic gain or Net Monetary Benefit (NMB) per million population (i.e., €288.9-€1038.5 million for Spain in ten years) [64]. Values are consistent after sensitivity analyses and the proportion of mortality in the UK.…”

Retail store customer flow and COVID-19 transmission

“…While vaccines are now available, they will take some time to distribute and administer, and during the next few months COVID-19 will continue to spread in many communities. Therefore, public health measures such as social distancing and wearing masks will remain important (2,3).…”

Impact of reproduction number on the multiwave spreading dynamics of COVID-19 with temporary immunity: A mathematical model

“…Briefly revisiting the prior Literature, we find that some prior works ( Giordano et al, 2020 , Bjørnstad et al, 2020 , Cooke and Van Den Driessche, 1996 , Trawicki, 2017 , Kiran et al, 2020 ) appear to have missed the multiple wave solutions possible with temporary immunity. While Kosinski (2020) and Sandmann et al (2020) do find these waves, they do not obtain the diverse possible epidemic trajectories depending on R . Since R is governed by public health interventions, our analysis reveals a subtle interconnection between immunity and public health, which together influence the fate of the pandemic.…”

“…Some of the limitations of the present study are the natural constraints associated with any compartmental or lumped parameter model. For example, the immunity duration used in the model has to be an average over the entire population, which can be refined to some degree by introducing age- or vulnerability-structuring ( Sandmann et al op. cit ).…”

“… Kosinski (2020) however finds multiple waves of COVID-19 if the immunity duration is finite. Sandmann et al (2020) , in an analysis of this situation in the context of a vaccine, find smooth oscillations about an endemic equilibrium, which change to jerky oscillations with periodic lockdown. In this Article, we show that the case trajectories with temporary immunity actually depend in an intricate manner on the reproduction number R .…”