Cost-effectiveness of Coronavirus Disease 2019 Vaccination in Low- and Middle-Income Countries

With circulating Omicron-like variants, increasing vaccination rates for COVID-19 to 30% or 45% of the population in each low- and middle-income country would have incremental cost-effectiveness ratios of $1040 and $3050, respectively, per year of life saved. Background Despite the advent of safe and effective coronavirus disease 2019 vaccines, pervasive inequities in global vaccination persist. Methods We projected health benefits and donor costs of delivering vaccines for up to 60% of the population in 91 low- and middle-income countries (LMICs). We modeled a highly contagious (R-e at model start, 1.7), low-virulence (infection fatality ratio [IFR], 0.32%) Omicron-like variant and a similarly contagious severe variant (IFR, 0.59%) over 360 days, accounting for country-specific age structure and healthcare capacity. Costs included vaccination startup (US$630 million) and per-person procurement and delivery (US$12.46/person vaccinated). Results In the Omicron-like scenario, increasing current vaccination coverage to achieve at least 15% in each of the 91 LMICs would prevent 11 million new infections and 120 000 deaths, at a cost of US$0.95 billion, for an incremental cost-effectiveness ratio (ICER) of US$670/year of life saved (YLS). Increases in vaccination coverage to 60% would additionally prevent up to 68 million infections and 160 000 deaths, with ICERs

Automated summary

In the presence of circulating Omicron-like variants, increasing vaccination rates for COVID-19 to 30% or 45% in low- and middle-income countries would be cost-effective in terms of saving lives. Increasing vaccination coverage to 60% would further prevent more infections and deaths, but at a higher cost.