Cost-effectiveness analysis of intradermal versus classical intramuscular COVID-19 vaccine administration: Specific concern on update situation due to emerging Omicron variant

Dear Editor, COVID-19 is still a global emergency with no effective treatment.[1] Vaccination is currently the best option for disaster management.[2] COVID-19 vaccination is now universally acknowledged as an effective primary COVID-19–preventive strategy. COVID-19 vaccination has been shown to be beneficial in preventing the disease. In most cases, two vaccine doses are given. It is necessary to administer two intramuscular vaccine doses. Many scientists provide strategies for reducing the risk and overcoming the problem of insufficient COVID-19 vaccination supplies by administering COVID-19 in a different way. Intradermal administration was proposed as a viable method for delivering reciprocal dosages while lowering vaccine costs and quantities.[3] In fact, when compared to full-dose immunization, fractional intradermal vaccination has been shown to be more immunogenic and effective. Indeed, for various pathogens, including influenza virus, rabies virus, poliovirus, hepatitis B virus, and hepatitis A virus, the immunogenicity and efficacy of fractional intradermal vaccination in comparison to full-dose immunization have been investigated and verified.[3] The cost and effectiveness of alternative vaccination administration are also crucial factors to consider. In some cases, the intradermal COVID-19 version is already in use. Concerns about the efficacy of the COVID-19 vaccination are currently focused on the impact of a new severe acute respiratory syndrome–related coronavirus 2 (SARS-CoV-2) variant. The Omicron variant is a current issue. Africa was the first place where this variation was discovered. The Omicron variation has ravaged numerous populations just 2 months after it originated, and it is quickly becoming the dominant coronavirus strain. Although global case numbers have reached new highs, the proportion of hospitalizations and deaths is lower than in prior outbreaks. The mutation inside the Omicron variation has been discovered and linked to decreased vaccination effectiveness. The decrease in vaccine efficacy has become a major source of concern. In comparison to prior variants of concern, Omicron has a considerable number of changes in S, most of which are centered around the receptor binding motif: 30 amino acid substitutions, six residue deletions, and three residue insertions.[1] Other regions (receptor binding domain and N-terminal domain) have mutations that could influence neutralizing antibodies. It is feared that Omicron will increase the likelihood of infecting those who have received vaccines with antigens based on the original S sequence. However, when the vaccine is delivered in a different way, the efficacy and cost-effectiveness of the vaccination become highly interesting topics. The authors compare the cost-effectiveness of alternative intradermal COVID-19 vaccine delivery to regular intramuscular COVID-19 vaccine administration in this study, with specific reference to the present problematic Omicron strain of SARS-CoV-2. This study focuses solely on mRNA COVID-19 vaccine delivery. The standard two-dose vaccine has been conditioned to a large extent. The authors examined two vaccine administration routes: intradermal and intramuscular injections. According to a recent paper, only 20% of the standard intramuscular mRNA vaccine dosage is injected intradermally for intradermal vaccine administration.[3] The unit cost of vaccine administration in our case (referencing local data, https://covid-19.kapook.com/view241253.html) is used in this work. According to publicly available information, one dose of COVID-19 administered through intramuscular injection costs 34.32 euros. To address the effect of the Omicron variant, the new data based on the study in our study are referred to. According to that study, the new developing variation causes a 20.8-fold drop in vaccine efficacy.[4] A direct total cost comparison of intradermal versus conventional intramuscular COVID-19 vaccination was undertaken for cost comparison. The investigation’s major data source is the publicly available information, which has already been described. For the purpose of analysis, the reported intended vaccination price is assigned to cost, while the indicated vaccine efficacy is assigned to effectiveness. Each COVID-19 vaccine administration’s cost per effectiveness is determined, and the cost-effectiveness value of vaccine administration is compared. According to a cost-effectiveness study with a specific focus on preventing the Omicron variant of SARS-CoV-2, the cost per unit efficacy of using intramuscular COVID-19 vaccine injection is higher than that of intradermal immunization [Table 1].Table 1: Cost-effectiveness analysis comparing between intradermal and intramuscular COVID-19 vaccine administration with specific reference to preventing against Omicron variant of SARS-CoV-2The researchers utilized a cost-effectiveness analysis to look at the cost and efficacy of the new COVID-19 vaccines, which will be available to the general public soon. The cost is calculated directly from public data, as previously indicated. In terms of efficacy, the previous comparison study’s reported that vaccine efficacy is mentioned. The efficiency of COVID-19 vaccination is measured as the rate of SARS-CoV-2 antireceptor binding domain antibody response relative to no immunization 1 month later. According to the referring study, the efficiency of intradermal versus normal intramuscular COVID-19 vaccine administration against nonvariant strains is equal to 38 and 75 times, respectively.[3] An adjustment is made via direct mathematical extraction of reduced vaccine efficacy due to the Omicron form as previously discussed.[4] According to the model, the final derived effectiveness will be equal to the reported efficacy of the naive strain minus the reported reduced efficacy of the vaccine. In the case of the nonvariant strain, a recent investigation suggested that intradermal COVID-19 vaccine injections elicited a strong immunological response. Despite a change in vaccine efficacy, when the cost-effectiveness model is applied to the Omicron form, intradermal COVID-19 vaccine injection has a 1.59-fold lower cost per effectiveness in necessary cost per unit effectiveness. For preventing the Omicron form, intradermal vaccination is a more cost-effective and practical option than the traditional intramuscular COVID-19 vaccine. Intradermal COVID-19 vaccine is still more cost-effective than standard intramuscular COVID-19 vaccination, according to the current studies. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.