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

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 CostEffectiveness 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 willingnessto-pay threshold (WTP) equivalent to 1 time the Gross Domestic Product (GDP) per capita, approximately $4091 US. One-way sensitivity analysis was conducted to ensure the reliability of the results. Results: Overall, 2098495 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 nonvaccination across all age groups. Vaccinating elderly individuals proved to be the most costeffective 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.