Cost-effectiveness analysis of BNT162b2 COVID-19 booster vaccination in the United States

Rui Li, Hanting Liu, Christopher K. Fairley, Zhuoru Zou, Li Xie, Xinghui Li, Mingwang Shen, Yan Li, Lei Zhang

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31 Citations (Scopus)


Objectives: To evaluate the cost-effectiveness of a booster strategy in the United States. Methods: We developed a decision-analytic Markov model of COVID-19 to evaluate the cost-effectiveness of a booster strategy of the Pfizer-BioNTech BNT162b2 (administered 6 months after the second dose) among older adults from a healthcare system perspective. Results: Compared with 2 doses of BNT162b2 without a booster, the booster strategy in a 100,000 cohort of older adults would incur an additional cost of $3.4 million in vaccination cost but save $6.7 million in direct medical cost and gain 3.7 quality-adjusted life-years in 180 days. This corresponds to a benefit-cost ratio of 1.95 and a net monetary benefit of $3.4 million. Probabilistic sensitivity analysis indicates that a booster strategy has a high chance (67%) of being cost-effective. Notably, the cost-effectiveness of the booster strategy is highly sensitive to the population incidence of COVID-19, with a cost-effectiveness threshold of 8.1/100,000 person-day. If vaccine efficacies reduce by 10%, 30%, and 50%, this threshold will increase to 9.7/100,000, 13.9/100,000, and 21.9/100,000 person-day, respectively. Conclusion: Offering the BNT162b2 booster to older adults aged ≥65 years in the United States is likely to be cost-effective. Less efficacious vaccines and boosters may still be cost-effective in settings of high SARS-CoV-2 transmission.

Original languageEnglish
Pages (from-to)87-94
Number of pages8
JournalInternational Journal of Infectious Diseases
Publication statusPublished - Jun 2022


  • BNT162b2
  • Booster
  • Cost-effective analysis
  • COVID-19
  • Markov model

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