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Bilgin GM, Munira SL, Lokuge K, Glass K. Cost-effectiveness analysis of COVID-19 booster doses and oral antivirals: Case studies in the Indo-Pacific. PLoS One 2024; 19:e0294091. [PMID: 39348348 PMCID: PMC11441647 DOI: 10.1371/journal.pone.0294091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 09/13/2024] [Indexed: 10/02/2024] Open
Abstract
BACKGROUND Decision-makers in middle-income countries need evidence on the cost-effectiveness of COVID-19 booster doses and oral antivirals to appropriately prioritise these healthcare interventions. METHODS We used a dynamic transmission model to assess the cost-effectiveness of COVID-19 booster doses and oral antivirals in Fiji, Indonesia, Papua New Guinea, and Timor-Leste. We conducted cost-effectiveness analysis from both healthcare and societal perspectives using data collated from publicly available sources. We developed an interactive R Shiny which allows the user to vary key model assumptions, such as the choice of discounting rate, and view how these assumptions affect model results. FINDINGS Booster doses were cost saving and therefore cost-effective in all four middle-income settings from both healthcare and societal perspectives using 3% discounting. Providing oral antivirals was cost-effective from a healthcare perspective if procured at a low generic price (US$25) or middle-income reference price (US$250); however, their cost-effectiveness was strongly influenced by rates of wastage or misuse, and the ongoing costs of care for patients hospitalised with COVID-19. The cost or wastage of rapid antigen tests did not appear strongly influential over the cost-effectiveness of oral antivirals in any of the four study settings. CONCLUSIONS Our results support that COVID-19 booster programs are cost-effective in middle-income settings. Oral antivirals demonstrate the potential to be cost-effective if procured at or below a middle-income reference price of US$250 per schedule. Further research should quantify the rates of wastage or misuse of oral COVID-19 antivirals in middle-income settings.
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Affiliation(s)
- Gizem Mayis Bilgin
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | | | - Kamalini Lokuge
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Kathryn Glass
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
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Mahasing C, Suphanchaimat R, Teekasap P, Nittayasoot N, Wongsanuphat S, Thammawijaya P. Cost effectiveness analysis comparing varying booster intervals of vaccination policies to address COVID-19 situation in Thailand, 2023. PLoS One 2024; 19:e0310427. [PMID: 39288199 PMCID: PMC11407652 DOI: 10.1371/journal.pone.0310427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/31/2024] [Indexed: 09/19/2024] Open
Abstract
The COVID-19 booster immunization policy is cost-effective, but evidence on additional booster doses and appropriate strategies is scarce. This research compared the cost-effectiveness of annual, twice-a-year, and biennial booster dose policies. We performed stochastic modeling using compartmental susceptible-exposed-infectious-recovered models and a system dynamic model. We evaluated four policy scenarios: (1) hypothetical no-booster immunization policy; (2) twice-a-year vaccination policy; (3) annual vaccination policy; and (4) biennial vaccination policy. In addition, we conducted a one-way sensitivity analysis by adjusting R0 from 1.8 to 3.0 in all scenarios (epidemic stage) and by decreasing the vaccination cost by 50% at the end of the first year to reflect the current policy direction to enhance domestic vaccine production. Compared to non-booster policies, all three booster strategies reduced the number of cases, hospital admissions, and severe infections remarkably. Without a booster, total cases would reach 16,220,615 (95% confidence interval [CI] 6,726,550-29,661,112) by day 1,460, whereas, with a twice-a-year booster, the total cases would reach 597,901 (95% CI 526,230-694,458) in the same period. Even though the no booster scenario exhibited the lowest cost by approximately the first 500 days, by day 1,460 the biennial booster scenario demonstrated the lowest cost at 72.0 billion baht (95% CI 68.6-79.4 billion). The most cost-saving policy was the biennial booster scenario. The annual booster scenario also stood as a cost-effective option for most outcomes. In the epidemic stage and in an assumption where the vaccination costs dropped, all booster policies became more cost-effective or cost-saving compared with the main assumption. This study underscores the significance of the COVID-19 vaccine booster policy. Implementing policies should take into consideration cost-effectiveness, feasibility, and public communication.
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Affiliation(s)
- Chayanit Mahasing
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Rapeepong Suphanchaimat
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Pard Teekasap
- Faculty of Business Administration and Technology, Stamford International University, Prawet, Bangkok, Thailand
| | - Natthaprang Nittayasoot
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Suphanat Wongsanuphat
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Panithee Thammawijaya
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
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Klinmalai C, Srisala S, Sahakijpicharn T, Apiwattanakul N. Monitoring of adaptive immune responses in healthcare workers who received a Coronavirus disease 2019 vaccine booster dose. Health Sci Rep 2024; 7:e2250. [PMID: 39015422 PMCID: PMC11250167 DOI: 10.1002/hsr2.2250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024] Open
Abstract
Background and Aims Coronavirus disease 2019 (COVID-19) has become a global pandemic and led to increased mortality and morbidity. Vaccines against the etiologic agent; severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were approved for emergency use on different platforms. In the early phase of the pandemic, Thai healthcare workers (HCWs) received CoronaVac, an inactivated vaccine, as the first vaccine against SARS-CoV-2, followed by ChAdOx1 nCoV-19, a viral vector-based vaccine, or BNT162b2, an mRNA vaccine, as a booster dose. This preliminary study evaluated the immunogenicity of ChAdOx1 nCoV-19 and BNT162b2 as a booster dose in HCWs who previously received two doses of CoronaVac. Methods Ten HCW participants received ChAdOx1 nCoV-19 and another 10 HCWs received BNT162b2 as a booster dose after two doses of CoronaVac. Anti-RBD IgG, neutralizing antibodies (NAb), and cellular immunity, including interferon-gamma (IFN-γ)-releasing CD4, CD8, double negative T cells, and NK cells, were measured at 3 and 5 months after the booster dose. Results There was no significant difference in anti-RBD IgG levels at 3 and 5 months between the two different types of booster vaccine. The levels of anti-RBD IgG and NAb were significantly decreased at 5 months. HCWs receiving BNT162b2 had significantly higher NAb levels than those receiving ChAdOx1 nCoV-19 at 5 months after the booster dose. IFN-γ release from CD4 T cells was detected at 3 months with no significant difference between the two types of booster vaccines. However, IFN-γ-releasing CD4 T cells were present at 5 months in the ChAdOx1 nCoV-19 group only. Conclusion ChAdOx1 nCoV-19 or BNT162b2 can be used as a booster dose after completion of the primary series primed by inactivated vaccine. Although the levels of immunity decline at 5 months, they may be adequate during the first 3 months after the booster dose.
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Affiliation(s)
- Chompunuch Klinmalai
- Department of Paediatrics, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Supanart Srisala
- Research Center, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Thiantip Sahakijpicharn
- Department of Paediatrics, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Nopporn Apiwattanakul
- Department of Paediatrics, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
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Chang E, Li H, Zheng W, Zhou L, Jia Y, Gu W, Cao Y, Zhu X, Xu J, Liu B, You M, Liu K, Wang M, Huang W. Economic Evaluation of COVID-19 Immunization Strategies: A Systematic Review and Narrative Synthesis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:457-470. [PMID: 38598091 DOI: 10.1007/s40258-024-00880-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES This study aimed to systematically assess global economic evaluation studies on COVID-19 vaccination, offer valuable insights for future economic evaluations, and assist policymakers in making evidence-based decisions regarding the implementation of COVID-19 vaccination. METHODS Searches were performed from January 2020 to September 2023 across seven English databases (PubMed, Web of Science, MEDLINE, EBSCO, KCL-Korean Journal Dataset, SciELO Citation Index, and Derwent Innovations Index) and three Chinese databases (Wanfang Data, China Science and Technology Journal, and CNKI). Rigorous inclusion and exclusion criteria were applied. Data were extracted from eligible studies using a standardized data collection form, with the reporting quality of these studies assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022). RESULTS Of the 40 studies included in the final review, the overall reporting quality was good, evidenced by a mean score of 22.6 (ranging from 10.5 to 28). Given the significant heterogeneity in fundamental aspects among the studies reviewed, a narrative synthesis was conducted. Most of these studies adopted a health system or societal perspective. They predominantly utilized a composite model, merging dynamic and static methods, within short to medium-term time horizons to simulate various vaccination strategies. The research strategies varied among studies, investigating different doses, dosages, brands, mechanisms, efficacies, vaccination coverage rates, deployment speeds, and priority target groups. Three pivotal parameters notably influenced the evaluation results: the vaccine's effectiveness, its cost, and the basic reproductive number (R0). Despite variations in model structures, baseline parameters, and assumptions utilized, all studies identified a general trend that COVID-19 vaccination is cost-effective compared to no vaccination or intervention. CONCLUSIONS The current review confirmed that COVID-19 vaccination is a cost-effective alternative in preventing and controlling COVID-19. In addition, it highlights the profound impact of variables such as dose size, target population, vaccine efficacy, speed of vaccination, and diversity of vaccine brands and mechanisms on cost effectiveness, and also proposes practical and effective strategies for improving COVID-19 vaccination campaigns from the perspective of economic evaluation.
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Affiliation(s)
- Enxue Chang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Haofei Li
- School of Health Management, Harbin Medical University, Harbin, China
| | - Wanji Zheng
- School of Health Management, Harbin Medical University, Harbin, China
| | - Lan Zhou
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yanni Jia
- School of Health Management, Harbin Medical University, Harbin, China
| | - Wen Gu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Yiyin Cao
- School of Health Management, Harbin Medical University, Harbin, China
| | - Xiaoying Zhu
- School of Elderly Care Services and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Juan Xu
- Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen, China
| | - Bo Liu
- Shenzhen Health Capacity Building and Continuing Education Center, Shenzhen, China
| | - Mao You
- National Health Development Research Center, Beijing, 100191, China
| | - Kejun Liu
- National Health Development Research Center, Beijing, 100191, China.
| | - Mingsi Wang
- School of Health Management, Harbin Medical University, Harbin, China.
| | - Weidong Huang
- School of Health Management, Harbin Medical University, Harbin, China.
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Ounsaneha W, Laosee O, Rattanapan C. Influence of Environmental Risk Exposure on the Determinants of COVID-19 Booster Vaccination in an Urban Thai Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:745. [PMID: 38928991 PMCID: PMC11204251 DOI: 10.3390/ijerph21060745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
This study aimed to identify the influence of environmental risk exposure levels on the predictive factors of COVID-19 booster dose vaccination in an urban Thai population in the post-pandemic era. Six study locations, including the three provinces with the highest environmental risk levels and the three provinces with the lowest environmental risk levels, were selected by calculating the environmental risk exposure indexes. Participants from the capital district of each province were chosen via the simple random sampling technique and interviewed using a structured questionnaire. A total of 1315 individuals were included in a sample in this study, and the best predictors of booster dose vaccination were determined using multiple regression analysis. The results showed that a high level of environmental risk exposure occurred in the provinces with a high number of total days exceeding the limits set for PM10 and high rates of mortality for lung cancer. The number of COVID-19 booster vaccinations given amount to 43.4% of the population during the post-COVID-19 pandemic period. Our multivariate analysis indicated that individuals in the working age group (≥25 years old); those with higher education (diploma degree and above); full-time employment (government and private sectors); those with high monthly incomes (≥USD144.1); and those in areas with the lowest risk level of environmental exposure significantly contributed to the number of booster dose vaccinations given during the post-pandemic period. To summarize, the rate of COVID-19 booster dose vaccination acceptance in Thailand was influenced by socio-economic factors with environmental concerns. These findings improve our understating of both the global pandemic and how environmental exposure affects behavioral change patterns and could improve the effectiveness of post-pandemic management.
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Affiliation(s)
- Weerawat Ounsaneha
- Faculty of Science and Technology, Valaya Alongkorn Rajabhat University under the Royal Patronage Pathumthani Province, Klong Nuang, Klong Luang, Pathumthani 13180, Thailand;
| | - Orapin Laosee
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73710, Thailand;
| | - Cheerawit Rattanapan
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73710, Thailand;
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Nithichanon A, Kamuthachad L, Salao K, Phoksawat W, Kamsom C, Wongratanacheewin S, Pipattanaboon C, Kanthawong S, Yordpratum U, Aromseree S, Meesing A, Mootsikapun P, Edwards SW, Phanthanawiboon S. A two-arm analysis of the immune response to heterologous boosting of inactivated SARS-CoV-2 vaccines. Sci Rep 2023; 13:18762. [PMID: 37907584 PMCID: PMC10618206 DOI: 10.1038/s41598-023-46053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023] Open
Abstract
Several vaccine programs were introduced during the COVID-19 pandemic, which included inactivated virus, DNA viral vectors and mRNA vaccines. Booster programs are recommended, especially for those in high-risk groups. However, many of these booster programs involve heterologous vaccines. This study enrolled volunteers who first received two full-dose CoronaVac vaccinations before receiving heterologous boosters with DNA- and/or mRNA-vaccines for an additional 2 doses (n = 40) or an additional 3 doses (n = 16). Our results showed no difference in side effects, neutralizing antibodies, or T-cell responses for any of the heterologous vaccination programs. However, the neutralizing capacity and IFN-γ responses against the Omicron variant in volunteers who received 4 or 5 doses were improved. Polarization of peripheral memory T cells after stimulation in all booster groups with Omicron peptide showed an increased trend of naïve and central memory phenotypes of both CD4+ and CD8+ T cells, suggesting that exposure to Omicron antigens will drive T cells into a lymphoid resident T cell phenotype. Our data support a continuous vaccination program to maximize the effectiveness of immunity, especially in people at high risk. Furthermore, the number of boosting doses is important for maintaining immunity.
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Affiliation(s)
- Arnone Nithichanon
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand
| | - Ludthawun Kamuthachad
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kanin Salao
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand
| | - Wisitsak Phoksawat
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand
| | - Chatcharin Kamsom
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Sakawrat Kanthawong
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Umaporn Yordpratum
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sirinart Aromseree
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Atibordee Meesing
- Infectious Disease Unit, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Piroon Mootsikapun
- Infectious Disease Unit, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Steven W Edwards
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
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Türken A, Çapar H. Vaccine hesitancy in patients with COVID-19 who have back pain. Osong Public Health Res Perspect 2023; 14:100-109. [PMID: 37183330 PMCID: PMC10211457 DOI: 10.24171/j.phrp.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVES Musculoskeletal pain is among the most common symptoms in patients diagnosed with coronavirus disease 2019 (COVID-19), and it has placed a significant burden on health worldwide during the pandemic. This study explored vaccine hesitancy and associated factors in patients with positive COVID-19 polymerase chain reaction test results who were hospitalized and had back pain. METHODS A cross-sectional study was conducted among 170 hospitalized COVID-19 patients over 18 years of age. Data were analyzed using descriptive statistics with IBM SPSS ver. 25.0. RESULTS COVID-19 patients who were married considered COVID-19 vaccinations riskier than unmarried COVID-19 patients. Patients who had not been vaccinated expressed higher levels of distrust towards COVID-19 vaccines than patients who had been vaccinated. Participants had relatively little hesitation toward the Sinovac vaccine. High vaccine confidence was found in all participants regardless of vaccination status. Those who had not received the COVID-19 vaccine reported higher risk perceptions than those who had received at least 1 dose of any COVID-19 vaccine. CONCLUSION Measurements of the hesitancy of vaccinated and non-vaccinated patients or members of society towards vaccines can be an important parameter for health authorities to find solutions.
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Affiliation(s)
- Askeri Türken
- Department of Physical Medicine and Rehabilitation, Gazi Yaşargil Education and Research Hospital, University of Health Sciences, Diyarbakır, Turkey
| | - Haşim Çapar
- Department of Health Management, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
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Thakkar K, Spinardi J, Kyaw MH, Yang J, Mendoza CF, Ozbilgili E, Dodd J, Yarnoff B, Punrin S. Modelling the potential public health impact of different vaccination strategies with an omicron-adapted bivalent vaccine in Thailand. Expert Rev Vaccines 2023; 22:860-870. [PMID: 37779484 DOI: 10.1080/14760584.2023.2265460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/27/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 has continuously evolved, requiring the development of adapted vaccines. This study estimated the impact of the introduction and increased coverage of an Omicron-adapted bivalent booster vaccine in Thailand. RESEARCH DESIGN AND METHODS The outcomes of booster vaccination with an Omicron-adapted bivalent vaccine versus no booster vaccination were estimated using a combined cohort Markov decision tree model. The population was stratified into high- and standard-risk subpopulations. Using age-specific inputs informed by published sources, the model estimated health (case numbers, hospitalizations, and deaths) and economic (medical costs and productivity losses) outcomes in different age and risk subpopulations. RESULTS Booster vaccination in only the elderly and high-risk subpopulation was estimated to avert 97,596 cases 36,578 hospitalizations, 903 deaths, THB 3,119 million in direct medical costs, and THB 10,589 million in indirect medical costs. These benefits increased as vaccination was expanded to other subpopulations. Increasing the booster vaccination coverage to 75% of the standard-risk population averted more deaths (95%), hospitalizations (512%), infections (782%), direct costs (550%), and indirect costs (687%) compared to the base case. CONCLUSIONS Broader vaccination with an Omicron-adapted bivalent booster vaccine could have significant public health and economic benefits in Thailand.
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Affiliation(s)
| | - Julia Spinardi
- Medical and Scientific Affairs, Pfizer Inc, New York, NY, USA
| | - Moe H Kyaw
- Medical and Scientific Affairs, Pfizer Inc, New York, NY, USA
| | - Jingyan Yang
- Value and Evidence, Pfizer Inc, New York, NY, USA
| | | | | | - Josie Dodd
- Model and Simulation, Evidera Inc, London, UK of Great Britain and UK
| | - Ben Yarnoff
- Model and Simulation, Evidera Inc, London, UK of Great Britain and UK
| | - Suda Punrin
- Queen Saovabha Memorial Institute, Thai Red Cross Society, Bangkok, Thailand
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