Transitioning to routine immunization: Cost-effectiveness of a national COVID-19 vaccination program for older adults in South Korea

초록

Objectives: COVID-19 continues to evolve, yet it remains excluded from South Korea's National Immunization Program (NIP). This study assesses the cost-effectiveness of introducing COVID-19 vaccination into the NIP for older adults. Methods: A static decision-tree model was employed from a societal perspective to compare a single-dose NIP strategy against no vaccination for adults aged >65. Model inputs were derived from real-world data, assuming a 2-year average incidence and 6-month vaccine protection duration. Sensitivity and scenario analyses, including a budget impact analysis for 2025-2029, were performed. Results: The NIP strategy was estimated to prevent 3,011 deaths and 22,031 hospitalizations. The basecase incremental cost-effectiveness ratio (ICER) was KRW 9.17 million per quality-adjusted life year (QALY) gained, significantly below the willingness-to-pay threshold. ICERs remained robust across scenarios, ranging from KRW 3.44 million to 34.79 million. Targeting adults aged >= 75 further improved the ICER to KRW 2.94 million/QALY. Results were generally robust across sensitivity analyses, although epidemiology remained a key determinant. The annual budget impact was projected to reach KRW 581.9 billion by 2029 at 50% coverage. Conclusions: Introducing COVID-19 vaccination into the NIP for older adults is cost-effective. These findings provide a robust evidence base for long-term immunization planning in Korea and similar global contexts. (c) 2026 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

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