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

## TL;DR

This study evaluates how cost-effective the mass vaccination program was in Iran during the Omicron wave, showing it saved lives and was economically beneficial.

## Contribution

The study introduces an integrated Markov-SIR model to assess both health and economic impacts of vaccination in a real-world setting.

## Key findings

- Vaccination generated 2,098,495 extra QALYs at an additional cost of $853.78 million.
- The average ICER for adult vaccination was $406.85 per QALY, indicating high cost-effectiveness.
- Vaccinating the elderly was found to be the most cost-effective strategy.

## Abstract

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.

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.

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.

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.