Economic evaluation of COVID-19 vaccination in reducing hospitalisation and mortality in a South African insured population using real-world data
1
Health Economics Division, University of Cape Town, Cape Town, South Africa
2
Dept. of Statistical Sciences, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
COVID-19 placed strain on health systems in South Africa and globally, with significant morbidity, mortality, and healthcare costs[1-5]. While the clinical effectiveness of COVID-19 vaccines is well established[6-9], evidence on their real-world economic value in low- and middle-income country settings remains limited. This study assessed the cost-utility of COVID-19 vaccination in reducing COVID-19 related hospitalisation, morbidity, and mortality in a South African insured population using real-world data.
METHODS:
A retrospective cost-utility analysis based on recognised guidelines[10] was conducted from a third-party payer perspective using insurance claims data covering March 2020 to December 2022[11]. A cohort Markov decision-analytic model with two-week cycles and a lifetime horizon compared three strategies: no, partial, and full vaccination. Health states included asymptomatic infection, hospitalisation, partial recovery, full recovery, post-pandemic survival, and death. Outcomes included COVID-19 hospitalisations averted, deaths averted, life years gained, and quality-adjusted life years gained. Costs and outcomes were discounted at 3% annually. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty.
RESULTS:
Both partial and full vaccination strategies were associated with lower lifetime healthcare costs compared to no vaccination, driven by reduced hospitalisation costs. Vaccination reduced COVID-19 hospitalisations and deaths and resulted in gains in life years and quality-adjusted life years. Both vaccination strategies were dominant, yielding better health outcomes at lower overall costs. Cost-utility results remained consistent across sensitivity analyses. All quality-adjusted life year results fell well below the South African cost-effectiveness threshold.
CONCLUSIONS:
Using real-world data, COVID-19 vaccination was found to be a cost-effective and cost-saving intervention in the study population. The findings support the findings of other studies that have provided economic evidence confirming the importance of vaccination strategies in managing healthcare resource use and mortality during the pandemic[12-14]. Given the differences between insured and non-insured populations, caution should be exercised in generalizing the findings.
COVID-19 placed strain on health systems in South Africa and globally, with significant morbidity, mortality, and healthcare costs[1-5]. While the clinical effectiveness of COVID-19 vaccines is well established[6-9], evidence on their real-world economic value in low- and middle-income country settings remains limited. This study assessed the cost-utility of COVID-19 vaccination in reducing COVID-19 related hospitalisation, morbidity, and mortality in a South African insured population using real-world data.
METHODS:
A retrospective cost-utility analysis based on recognised guidelines[10] was conducted from a third-party payer perspective using insurance claims data covering March 2020 to December 2022[11]. A cohort Markov decision-analytic model with two-week cycles and a lifetime horizon compared three strategies: no, partial, and full vaccination. Health states included asymptomatic infection, hospitalisation, partial recovery, full recovery, post-pandemic survival, and death. Outcomes included COVID-19 hospitalisations averted, deaths averted, life years gained, and quality-adjusted life years gained. Costs and outcomes were discounted at 3% annually. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty.
RESULTS:
Both partial and full vaccination strategies were associated with lower lifetime healthcare costs compared to no vaccination, driven by reduced hospitalisation costs. Vaccination reduced COVID-19 hospitalisations and deaths and resulted in gains in life years and quality-adjusted life years. Both vaccination strategies were dominant, yielding better health outcomes at lower overall costs. Cost-utility results remained consistent across sensitivity analyses. All quality-adjusted life year results fell well below the South African cost-effectiveness threshold.
CONCLUSIONS:
Using real-world data, COVID-19 vaccination was found to be a cost-effective and cost-saving intervention in the study population. The findings support the findings of other studies that have provided economic evidence confirming the importance of vaccination strategies in managing healthcare resource use and mortality during the pandemic[12-14]. Given the differences between insured and non-insured populations, caution should be exercised in generalizing the findings.
| eISSN: | 2654-1459 |
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