Assessing the Economic Benefit of Mass COVID-19 Vaccination Program in Iran: A Real-World Modeling Study

Document Type : Original Article

Authors

1 Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran

2 Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

4 Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran

5 Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

6 Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran

7 Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

8 Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

9 Clinical Tuberculosis and Epidemiology Research Center, National Research Institute for Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

10 Department of Cardiology, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

11 Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

12 Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Bulent Ecevit University, Zonguldak, Turkey

13 Department of Biotechnology, Islamic Azad University of Medical Science, Tehran, Iran

14 Health Economic Department, School of Medicine, Shahed University, Tehran, Iran

15 Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background 
The global challenges posed by COVID-19 vaccinations require careful consideration by decision-makers at both the global and national levels, particularly in developing countries. This study aimed to evaluate the health and economic implications of implementing vaccination programs. 
 
Methods 
Two scenarios, one involving vaccination and the other without, were analyzed using the Markov susceptible-infectious-recovered (SIR) model. For the vaccination scenario, real-world data, such as age-specific vaccination coverage, hospitalization rates, and mortality, were obtained from the Medical Care Monitoring Center (MCMC) and national COVID-19 registry during the Omicron wave in Iran. For the counterfactual non-vaccination scenario, we relied on model-based assumptions using published literature and expert input to estimate infection rates and clinical outcomes in the absence of vaccination. The incremental cost-effectiveness ratio (ICER) of the COVID-19 vaccination program was calculated by comparing the incremental cost per unit of quality-adjusted life year (QALY) generated to a willingness-to-pay (WTP) threshold equivalent to 1 time the gross domestic product (GDP) per capita, approximately US$4091. One-way sensitivity analysis was conducted to ensure the reliability of the results. 
 
Results 
Overall, 2 098 495 extra QALYs were generated by vaccination, incurring a total extra cost of $853.78 million. The vaccination program resulted in an average of 0.035 incremental QALYs at an additional cost of $14.08 per person. The average ICER for adult vaccination was $406.85 per QALY, indicating that it is a highly cost-effective strategy compared to non-vaccination across all age groups. Vaccinating elderly individuals proved to be the most cost-effective approach among all age categories. 
 
Conclusion 
The integrated Markov-SIR model used in this study provides valuable insights into both the health and economic impact of the COVID-19 vaccination program in Iran. These findings support the implementation of vaccination strategies and provide a framework for decision-makers to consider when formulating policies. 

Keywords

References

  1. Chitiga-Mabugu M, Henseler M, Mabugu R, Maisonnave H. Economic and distributional impact of COVID-19: evidence from macro-micro modelling of the South African economy. S Afr J Econ. 2021;89(1):82-94. doi:1111/saje.12275
  2. World Health Organization (WHO). WHO COVID-19 Dashboard. Geneva: WHO; 2020. https://covid19.who.int/. Accessed April 15, 2023.
  3. Nicola M, Alsafi Z, Sohrabi C, et al. The socio-economic implications of the coronavirus pandemic (COVID-19): a review. Int J Surg. 2020;78:185-193. doi:1016/j.ijsu.2020.04.018
  4. Xiong X, Li J, Huang B, et al. Economic value of vaccines to address the COVID-19 pandemic in Hong Kong: a cost-effectiveness analysis. Vaccines (Basel). 2022;10(4):495. doi:3390/vaccines10040495
  5. Rodrigues CM, Plotkin SA. Impact of vaccines; health, economic and social perspectives. Front Microbiol. 2020;11:1526. doi:3389/fmicb.2020.01526
  6. Wang Y, Luangasanatip N, Pan-Ngum W, et al. Assessing the cost-effectiveness of COVID-19 vaccines in a low incidence and low mortality setting: the case of Thailand at start of the pandemic. Eur J Health Econ. 2023;24(5):735-748. doi:1007/s10198-022-01505-2
  7. Marco-Franco JE, Pita-Barros P, González-de-Julián S, Sabat I, Vivas-Consuelo D. Simplified mathematical modelling of uncertainty: cost-effectiveness of COVID-19 vaccines in Spain. Mathematics. 2021;9(5):566. doi:3390/math9050566
  8. Carvalho N, Jit M, Cox S, Yoong J, Hutubessy RCW. Capturing budget impact considerations within economic evaluations: a systematic review of economic evaluations of rotavirus vaccine in low- and middle-income countries and a proposed assessment framework. Pharmacoeconomics. 2018;36(1):79-90. doi:1007/s40273-017-0569-2
  9. Bowrin K, Briere JB, Levy P, Millier A, Clay E, Toumi M. Cost-effectiveness analyses using real-world data: an overview of the literature. J Med Econ. 2019;22(6):545-553. doi:1080/13696998.2019.1588737
  10. Pearson CA, Bozzani F, Procter SR, et al. COVID-19 vaccination in Sindh province, Pakistan: a modelling study of health impact and cost-effectiveness. PLoS Med. 2021;18(10):e1003815. doi:1371/journal.pmed.1003815
  11. Mauskopf J, Standaert B, Connolly MP, et al. Economic analysis of vaccination programs: an ISPOR good practices for outcomes research task force report. Value Health. 2018;21(10):1133-1149. doi:1016/j.jval.2018.08.005
  12. Wong CK, Liao Q, Guo VY, Xin Y, Lam CL. Cost-effectiveness analysis of vaccinations and decision makings on vaccination programmes in Hong Kong: a systematic review. Vaccine. 2017;35(24):3153-3161. doi:1016/j.vaccine.2017.04.050
  13. Kohli M, Maschio M, Becker D, Weinstein MC. The potential public health and economic value of a hypothetical COVID-19 vaccine in the United States: use of cost-effectiveness modeling to inform vaccination prioritization. Vaccine. 2021;39(7):1157-1164. doi:1016/j.vaccine.2020.12.078
  14. Li R, Liu H, Fairley CK, et al. Cost-effectiveness analysis of BNT162b2 COVID-19 booster vaccination in the United States. Int J Infect Dis. 2022;119:87-94. doi:1016/j.ijid.2022.03.029
  15. World Health Organization (WHO). WHO Guide to Cost Effectiveness Analysis. Geneva: WHO; 2003. Published Online 2018.
  16. Neumann PJ, Sanders GD, Russell LB, Siegel JE, Ganiats TG. Cost-Effectiveness in Health and Medicine. Oxford University Press; 2016.
  17. Havers FP, Pham H, Taylor CA, et al. COVID-19-associated hospitalizations among vaccinated and unvaccinated adults 18 years or older in 13 US states, January 2021 to April 2022. JAMA Intern Med. 2022;182(10):1071-1081. doi:1001/jamainternmed.2022.4299
  18. Bartsch SM, Ferguson MC, McKinnell JA, et al. The potential health care costs and resource use associated with COVID-19 in the United States. Health Aff (Millwood). 2020;39(6):927-935. doi:1377/hlthaff.2020.00426
  19. Jassat W, Abdool Karim SS, Mudara C, et al. Clinical severity of COVID-19 in patients admitted to hospital during the omicron wave in South Africa: a retrospective observational study. Lancet Glob Health. 2022;10(7):e961-e969. doi:1016/s2214-109x(22)00114-0
  20. Jamaati H, Karimi S, Ghorbani F, et al. Effectiveness of different vaccine platforms in reducing mortality and length of ICU stay in severe and critical cases of COVID-19 in the omicron variant era: a national cohort study in Iran. J Med Virol. 2023;95(3):e28607. doi:1002/jmv.28607
  21. Maleki B, Sadeghian AM, Ranjbar M. Impact of vaccination against SARS-CoV-2 on mortality risk, ICU admission rate, and hospitalization length in hospitalized COVID-19 patients: a cross-sectional study. BMC Infect Dis. 2025;25(1):144. doi:1186/s12879-025-10530-4
  22. Huang Z, Luo J, Li H, et al. Incidence, risk factors, and clinical symptom profile of reinfection during omicron-dominated COVID-19 outbreak in Hong Kong: a retrospective cohort study. medRxiv [Preprint]. March 15, 2024. Available from: https://www.medrxiv.org/content/10.1101/2024.03.12.24303945v1.
  23. Cai J, Zhang H, Zhu K, et al. Risk of reinfection and severity with the predominant BA.5 omicron subvariant China, from December 2022 to January 2023. Emerg Microbes Infect. 2024;13(1):2292071. doi:1080/22221751.2023.2292071
  24. Yang SL, Teh HS, Suah JL, Husin M, Hwong WY. SARS-CoV-2 in Malaysia: a surge of reinfection during the predominantly omicron period. Lancet Reg Health West Pac. 2022;26:100572. doi:1016/j.lanwpc.2022.100572
  25. Ukwishaka J, Ndayishimiye Y, Destine E, Danwang C, Kirakoya-Samadoulougou F. Global prevalence of coronavirus disease 2019 reinfection: a systematic review and meta-analysis. BMC Public Health. 2023;23(1):778. doi:1186/s12889-023-15626-7
  26. World Health Organization (WHO). Clinical Management of COVID-19. https://www.who.int/teams/health-care-readiness/covid-19.
  27. Roser M, Ritchie H, Ortiz-Ospina E, Hasell J. Coronavirus disease (COVID-19)–statistics and research. Our World in Data. 2020;4:1-45.
  28. Xu S, Li J, Wang H, Wang F, Yin Z, Wang Z. Real-world effectiveness and factors associated with effectiveness of inactivated SARS-CoV-2 vaccines: a systematic review and meta-regression analysis. BMC Med. 2023;21(1):160. doi:1186/s12916-023-02861-3
  29. Huang Z, Xu S, Liu J, et al. Effectiveness of inactivated and Ad5-nCoV COVID-19 vaccines against SARS-CoV-2 omicron BA.2 variant infection, severe illness, and death. BMC Med. 2022;20(1):400. doi:1186/s12916-022-02606-8
  30. Higdon MM, Wahl B, Jones CB, et al. A systematic review of coronavirus disease 2019 vaccine efficacy and effectiveness against severe acute respiratory syndrome coronavirus 2 infection and disease. Open Forum Infect Dis. 2022;9(6):ofac138. doi:1093/ofid/ofac138
  31. Javanbakht M, Moradi-Lakeh M, Yaghoubi M, et al. Cost-effectiveness analysis of the introduction of rotavirus vaccine in Iran. Vaccine. 2015;33 Suppl 1:A192-A200. doi:1016/j.vaccine.2014.12.035
  32. Infographic of the Prices of Some COVID-19 Vaccines in Iran and the World. ISNA; 2021. https://www.isna.ir/news/1400063022860/%25D8%25A7%25DB%258.
  33. Statistical Center of Iran. https://amar.org.ir/work#app3050.
  34. Emrani Z, Akbari Sari A, Zeraati H, Olyaeemanesh A, Daroudi R. Health-related quality of life measured using the EQ-5D-5 L: population norms for the capital of Iran. Health Qual Life Outcomes. 2020;18(1):108. doi:1186/s12955-020-01365-5
  35. Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S. Thresholds for the cost-effectiveness of interventions: alternative approaches. Bull World Health Organ. 2015;93(2):118-124. doi:2471/blt.14.138206
  36. Moore S, Hill EM, Dyson L, Tildesley MJ, Keeling MJ. Modelling optimal vaccination strategy for SARS-CoV-2 in the UK. PLoS Comput Biol. 2021;17(5):e1008849. doi:1371/journal.pcbi.1008849
  37. Reddy KP, Fitzmaurice KP, Scott JA, et al. Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa. medRxiv [Preprint]. November 13, 2021. Available from: https://www.medrxiv.org/content/10.1101/2021.05.07.21256852v2.
  38. Moghadas SM, Vilches TN, Zhang K, et al. The impact of vaccination on coronavirus disease 2019 (COVID-19) outbreaks in the United States. Clin Infect Dis. 2021;73(12):2257-2264. doi:1093/cid/ciab079
  39. Rasambainarivo F, Ramiadantsoa T, Raherinandrasana A, et al. Prioritizing COVID-19 vaccination efforts and dose allocation within Madagascar. BMC Public Health. 2022;22(1):724. doi:1186/s12889-022-13150-8
  40. Orangi S, Ojal J, Brand SP, et al. Epidemiological impact and cost-effectiveness analysis of COVID-19 vaccination in Kenya. BMJ Glob Health. 2022;7(8):e009430. doi:1136/bmjgh-2022-009430
  41. Utami AM, Rendrayani F, Khoiry QA, Alfiani F, Kusuma AS, Suwantika AA. Cost-effectiveness analysis of COVID-19 vaccination in low- and middle-income countries. J Multidiscip Healthc. 2022;15:2067-2076. doi:2147/jmdh.S372000
  42. Zhou L, Yan W, Li S, et al. Cost-effectiveness of interventions for the prevention and control of COVID-19: systematic review of 85 modelling studies. J Glob Health. 2022;12:05022. doi:7189/jogh.12.05022
  43. Hagens A, İnkaya A, Yildirak K, et al. COVID-19 vaccination scenarios: a cost-effectiveness analysis for Turkey. Vaccines (Basel). 2021;9(4):399. doi:3390/vaccines9040399
  44. Acharya KP, Ghimire TR, Subramanya SH. Access to and equitable distribution of COVID-19 vaccine in low-income countries. NPJ Vaccines. 2021;6(1):54. doi:1038/s41541-021-00323-6
  45. Jiang Y, Cai D, Shi S. Economic evaluations of inactivated COVID-19 vaccines in six Western Pacific and South East Asian countries and regions: a modeling study. Infect Dis Model. 2022;7(1):109-121. doi:1016/j.idm.2021.12.002
  46. Utami AM, Rendrayani F, Khoiry QA, et al. Economic evaluation of COVID-19 vaccination: a systematic review. J Glob Health. 2023;13:06001. doi:7189/jogh.13.06001
  47. Siedner MJ, Alba C, Fitzmaurice KP, et al. Cost-effectiveness of coronavirus disease 2019 vaccination in low- and middle-income countries. J Infect Dis. 2022;226(11):1887-1896. doi:1093/infdis/jiac243

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History

  • Received Date: 15 October 2024
  • Revised Date: 04 August 2025
  • Accepted Date: 31 August 2025
  • First Published Date: 06 September 2025
  • Published Date: 01 December 2025

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