Objective This study aims to assess the cost-effectiveness of the Fall 2023 COVID-19 mRNA XBB.1.5 vaccination campaign in the Netherlands, comparing the XBB1.5 updated mRNA-1273.222 with the XBB1.5 updated BNT162b2 vaccine.

Methods A one-year decision tree-based cost-effectiveness model was developed, considering three scenarios: no Fall 2023 vaccination, BNT162b2 vaccination and mRNA-1273 vaccination in the COVID-19 high-risk population in the Netherlands. The high-risk population includes everyone of 60 and older, and younger adults at high risk as identified by the Dutch Health Council. Costs were included from a societal perspective and the modelled period started in October 2023 and ended in September 2024, including life years lost with a lifetime horizon. Sensitivity and scenario analyses were conducted to evaluate model robustness.

Results In the base case, mRNA-1273 demonstrated substantial benefits over BNT162b2, potentially averting 20,629 symptomatic cases, 924 hospitalizations (including 32 ICU admissions), 207 deaths, and 2,124 post-COVID cases. Societal cost savings were €12.9million (excluding vaccination costs), with 1,506 QALYs gained. The break-even incremental price of mRNA-1273 compared to BNT162b2 was €16.72 or €34.32 considering a willingness to pay threshold (WTP) of 20,000 or 50,000 euro per QALY gained.

Conclusion This study provides a comprehensive cost-effectiveness analysis supporting the adoption of the mRNA-1273 vaccine in the national immunization programme in the Netherlands, provided that the Dutch government negotiates a vaccine price that is at most €34.32 per dose higher than BNT162b2. Despite limitations, the findings emphasize the substantial health and economic benefits of mRNA-1273 over BNT162b2 in the high-risk population.

Prof. Dr. Maarten J. Postma and Prof. Dr. Cornelis Boersma received grants and honoraria from various pharmaceutical companies, inclusive those developing, producing and marketing vaccines. Tjalke Westra and Ekkehard Beck are an employee and shareholder of Moderna, Inc.

Funding for this research was provided by Moderna, Inc.

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