OBJECTIVES:

To explore the ways in which a pandemic may alter the immediate and ongoing cost-effectiveness assessment of a vaccine, using COVID-19 as an example.

METHODS:

When gripped by a pandemic of the magnitude and severity of COVID-19, the health impact on individuals and health services, and the economic consequences of the ensuing lockdowns, mean that there is little debate around the cost-effectiveness of vaccines that allowed the return to something approaching a normal existence. With the ongoing need to maintain vaccine coverage, the appearance of new vaccines on the market and a global cost-of-living crisis, these debates are starting to take place, but have the rules changed? What is the nature of the “new normal” and what does it mean for cost-effectiveness analyses of COVID-19 vaccines?

RESULTS:

For the first vaccines available, the comparison with no vaccination and the associated health and economic cost mean that even a modestly effective vaccine with a favourable clinical profile would be cost-effective. As the pandemic starts to be controlled and new vaccines arrive comparisons re-centre on existing vaccines. We postulate that the immense strain placed on health services by the pandemic has increased the cost of health care, pushing up the cost of gaining a quality-adjusted life year (QALY), thereby reducing the opportunity cost of funding a new vaccine and so raising the cost-effectiveness threshold. If such revised thresholds were adopted by reimbursement bodies, this would make it harder for vaccines with a lower efficacy to be made cost-effective by a reduction in price alone. If the pandemic has indeed increased the cost of a QALY, then we might further postulate that the cost-effectiveness threshold is now a function of COVID-19 incidence.

CONCLUSIONS:

This would have consequences beyond interventions targeting COVID-19.