Cost-effectiveness and cost-utility of COVID-19 vaccination in a South African privately insured population: a real-world claims-based analysis.

backgroundCOVID-19 placed strain on healthcare systems globally, including South Africa. While vaccine effectiveness is well established, context-specific evidence on the economic value of COVID-19 vaccination in African and real-world settings remains limited. This study evaluates the cost-effectiveness and cost-utility of COVID-19 vaccination within a South African population with private health insurance between 1 March 2020 and 30 December 2022 using claims data.

methodsA state-transition Markov model was developed in TreeAge Pro 2025 from a third-party payer perspective, comparing non-vaccination, partial vaccination, and full vaccination. Disease progression was simulated over a 60-year lifetime horizon using two-week cycles to capture acute and long-term health outcomes. Model inputs, including COVID-19-related hospitalisations, mortality, healthcare utilisation, and costs, were derived from insurance claims data for 550,332 individuals enrolled in two private health insurance funds during the study period. Outcomes included hospitalisations and deaths averted, life years (LYs) gained, and quality-adjusted life years (QALYs) gained. Costs and outcomes were discounted at 0% and 3% annually. Incremental cost-effectiveness and cost-utility ratios were calculated, and parameter uncertainty was assessed using one-way and probabilistic sensitivity analysis.

resultsBoth partial and full vaccination strategies were associated with fewer base case hospitalisations and deaths, minor gains in life years and QALYs, and lower lifetime discounted costs per individual at base, with $49.32 for non-vaccination, $23.32 for partial vaccination, and $49.08 for full vaccination. Partial vaccination was dominant compared to non-vaccination, while full vaccination was cost-saving at base case and in most simulations. Compared to partial vaccination, full vaccination provided little QALY gains at an incremental cost of $25.72 per individual, resulting in an ICUR of $64,424 per QALY gained.

conclusionUsing real-world insurance claims data, COVID-19 vaccination was associated with improved long-term health outcomes within a South African privately insured population, with partial vaccination being cost-saving. The second dose provided limited additional value in this lower-risk cohort. These findings indicate that funding vaccination during the pandemic represented an efficient allocation of healthcare resources within the insured sector. Caution is warranted in generalising these results beyond populations with different demographic and risk profiles.