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Life sciences · Journal article
Expert Review of Vaccines · November 3, 2026
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BACKGROUND: Older adults and those with comorbidities have increased risk of severe disease and mortality from COVID-19. This analysis estimated the cost-effectiveness of COVID-19 vaccination versus no vaccination in the US and potential impact of increased vaccine coverage. RESEARCH DESIGN AND METHODS: A Markov-based model was updated using the latest epidemiology and vaccine reactogenicity data. Cases, costs, and outcomes for individuals aged 18-64 with ≥1 comorbidity and ≥65 years were estimated for NVX-CoV2705 (Nuvaxovid) versus no vaccination from a third-party payer perspective. Scenario analyses considered the societal perspective and analogous comparisons for BNT162b2 (Comirnaty), mRNA-1273 (Spikevax), and mRNA-1283 (mNEXSPIKE). Results were scaled for public health impact analyses. RESULTS: Base-case results associated NVX-CoV2705 with fewer cases (0.0447), hospitalizations (0.0037), and deaths (0.0004) per person on average. NVX-CoV2705 yielded an ICER of $9,840/QALY gained, reflecting fewer QALYs lost (0.0039) alongside increased direct costs ($38.09) per person. Differences for mRNA vaccines were driven by price and reactogenicity. Increasing vaccine coverage by 5-15 percentage points resulted in 114-341 hospitalizations and 11-33 deaths averted per 1,000,000 individuals. CONCLUSIONS: NVX-CoV2705 was predicted to be cost-effective over no vaccination. This analysis included a more granular approach to modeling reactogenicity events, an important consideration in vaccine cost-effectiveness analyses.