PONE-D-23-34679Cost-effectiveness analysis of COVID-19 booster doses and oral antivirals in the Indo-PacificPLOS ONE

Dear Dr. Bilgin,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Feb 09 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Harapan Harapan, MD, PhD

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at 

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Note from Emily Chenette, Editor in Chief of PLOS ONE, and Iain Hrynaszkiewicz, Director of Open Research Solutions at PLOS: Did you know that depositing data in a repository is associated with up to a 25% citation advantage (https://doi.org/10.1371/journal.pone.0230416)? If you’ve not already done so, consider depositing your raw data in a repository to ensure your work is read, appreciated and cited by the largest possible audience. You’ll also earn an Accessible Data icon on your published paper if you deposit your data in any participating repository (https://plos.org/open-science/open-data/#accessible-data).

3. Please ensure that you refer to Figure 3 in your text as, if accepted, production will need this reference to link the reader to the figure.

4. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 3 in your text; if accepted, production will need this reference to link the reader to the Table.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: No

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for the opportunity. Please find below my comments:

[Abstract]

1. State how or where the data were derived from.

2. Authors stated that the findings support the government program to be cost-effective. This statement sounds like the government make the same cost-effective analysis and the authors compared their findings with that of government's. I believe this is due to writing technicalities. Authors should revise the sentence so that it won't sound that as if the government make the same study.

[Introduction]

1.Line 47-48. Data about COVID-19 mortality and morbidity are fluctuative since the disease is newly emerged. Please state when the data was recorded.

2. Authors should provide why it is important to perform cost-effective study, this include its correlation with vaccine acceptance level. (for example, authors may incorporate findings from this study: Narra J. 2022. 2(2): e85)

3. Other than being previously studied (by the same authors), justification on choosing Fiji, Indonesia, etc. should be provided in introduction.

[Methods]

1. What do authors mean by societal and healthcare perspectives?

2. Please state how the data were collected in the study design.

3. Line 140-142. It is not clear how the assumption was made for the future vaccine products of choice.

[Results]

1. Focus the paragraph to present the data -- not repeating the methods.

[Discussion]

1. Line 380-381. Other than being politically sensitive, some of the countries might suffer from their inability to collect proper data (absence of electronic records for instance or low survaillance for drug misuse).

2.Authors mentioned about nirmatrelvir-ritonavir, but before this drugs there have been several antivirals used to treat SARS-CoV-2, please discuss them as well, and how the use of those drugs implicate the present study. (author may incorporate this study: Narra J. 2022. 2(3):e92)

[Conclusion]

1. Your findings support the continuation of gov-funded COVID-19 vaccination and procurement of oral anti-SARS-CoV-2. Please make clear about the assumption used in the study, and how the findings are not generalizable. For example, data about COVID-19 fatality and transmission is keep changing through times (if not months). Will your study still relevant if the fatality/transmission rate changes?

Reviewer #2: I would like to congratulate the authors for this important work. This study gives a good insight into estimation of the cost-effectiveness related to covid-19 vaccine. The authors have done a great work and stated all the analytical assumption behind the outputs. However, there are some major issues that the authors should address:

Major comment

1. The use of QALY derived from VSL which estimated the value of 1 QALY to $580,000. This means the willingness to pay/threshold should be more than $580,000 as per the study by Robinson LA. Estimating the QALY gained by averting mild, moderate, or severe cases of COVID should be done first by a valid HRQOL instrument like EQ5D (https://euroqol.org/support/analysis-tools/index-value-set-calculators/) and then changed to utility score using societal valuation (tariff) for the specific countries. Therefore, the authors need to clarify why they used estimates done by Robinson LA. If this is justified, the study needs alternative analysis method to estimate QALYs.

2. Supplementary file table 2 also mention a huge difference in QALY for mild, severe, fatal cases and critical cases. The QALY values have a huge gap, perhaps due to considering future health states for 2 of the health outcomes and not considering future health states for the other outcomes. Therefore, the authors need to provide the formula on how each of the QALYs for the mild, critical, severe, and fatal condition are calculated.

3. Line 89-95 time horizon of one year is used, if so we do not need to discount using 3%. However, the time horizon looks life time when the supplementary table 2 is seen.

Minor comments

1. The report is well written in detail but it needs restructuring it. To structure the report, please use CHEERS 2022 guideline as it can be a guide for the authors on how to structure this report. this will make it easy for the readers to follow.

2. The paper needs to be corrected for some typos.

3. The result section needs to have numbers reported in it. Example: when doing probabilistic sensitivity analysis, the authors should report the probability of being cost-effective with percentage.

4. In the method section, we need to include the threshold that is used for each country (GDP per capita) and explain why it is preferred.

Line by line comments

Abstract: line 3 repeated statement of 3% discount rate.

Abstract: Line 29, 30 A low generic. Do you mean generic price for low-income countries? Please, correct the sentence.

Abstract Line 32 Please, do not use subjective terms like “Interestingly”.

Abstract Line 37: I would recommend not using “continue to be”, as this study will make it look the authors are doing this study for the second time.

Abstract Line 38: “$250 USD”; please correct this to” US$ 250”

Line 59-63: three of the countries are classified as middle-income. Page 4 line 69-73: informs this estimation is for middle-income countries. I recommend the generalizability from this study for middle-income countries, not low-and middle-income countries.

Line 89-95: For a time horizon of one year, we do not need to discount the cost and effect. Discounting will only be applicable for cost and effects that lasts more than one year.

Line 146-47: I suggest all reference estimates to represent middle-income countries only to estimate the operational cost.

Please, write the title of all the figures

Figure 1: please correct figure 1 vertical axis to “incremental QALY gained”, not “QALY averted”

Figure 2: I would suggest not using negative willingness to pay threshold.

Again correct the QALY averted to QALY gained.

Supplementary table 2: in Fiji for age group 0 to 4; QALY= 0.01 for mild, 0.021 for severe, 4.884 for critical cases, and 26.6 for fatal cases.

The above figure looks the QALYs gained for mild, severe, critical, and fatal cases were calculated in different ways. I can see that the QALY for mild and severe are calculated without considering health gains. However, the QALY for critical and fatal cases are calculated using 3% discount rate including the future health gains. Therefore, I strongly recommend for the authors to do the analysis again with the support of senior health economist. In addition, please note that QALY of 1 means the person is in a prefect health and QALY of 0 means the person is dead in a year per person. The authors also need to correct the words “QALY loss” to QALY gain.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Amanuel Yigezu

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: COVID-19 boosted.docx

PONE-D-23-34679R1Cost-effectiveness analysis of COVID-19 booster doses and oral antivirals in the Indo-PacificPLOS ONE

Dear Dr. Bilgin,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Aug 09 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Dominic Luke Thorrington, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

The reviewers have highlighted some minor points in the manuscript that still require clarifications and further explanation.

Further information is required on the data that were retrieved from public sources - the reviewers are not convinced that this is sufficient for other researchers to be able to replicate the analysis. In addition, some clarifications from reviewer 2 concerning the presentation of methods and results is important to address.

Please carefully consider all of the points raised by both reviewers.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for addressing my previous concerns. However, authors stated that the data were retrieved from 'publicly available sources'. This is not reproducible and convincing. Authors should provide more detail and at least use several criteria for the data. Some countries might not appropriately collect their data, hence doubt on the methodology.

Reviewer #2: Please see some comments below.

1. Line 95-99: Response not addressed properly from previous comment 3. The authors are not providing a clear response. The authors should either do the analysis with 1 year timeframe without considering future morbidity (consequences in terms both cost and outcome) or multiple year by discounting future consequences (for both the cost and outcome). In economic evaluation, It is methodologically incorrect to consider one effect from life time horizon and the cost from a one year horizon.

2. Table 2 parameter estimation “Cost per extra day hospital length of stay” is not clear.

3. Probabilities that are used in the model are not described in table. Please provide the probabilities that are used to populate the SEIR model, all parameters used to populate the model should be presented on one table.

4. Line 254: please review the distribution used for the parameters. “Commonly used distributions In economic modelling are symmetrical, such as the normal distribution, often used for parameters such as population age and intervention effectiveness (e.g. relative risk reduction), or skewed, such as gamma or lognormal, for ratios or for parameters such as costs which cannot be negative.”

5. Please, explain the results with numbers. See my previous comment from last review.

“The result section needs to have numbers reported in it. Example: when doing probabilistic sensitivity analysis, the authors should report the probability of being cost-effective with percentage.”

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Amanuel Yigezu

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-23-34679R2Cost-effectiveness analysis of COVID-19 booster doses and oral antivirals in the Indo-PacificPLOS ONE

Dear Dr. Bilgin,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Sep 13 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Dominic Luke Thorrington, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

The latest round of review has resulted in a recommendation for further minor revisions, mainly some methodological clarifications and addressing some small short-comings. Please read the reviewer's response carefully to address all of their comments.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: The study evaluates the cost-effectiveness of COVID-19 booster doses and oral antivirals in the Indo-Pacific. However, the countries covered are Fiji, Indonesia, Papua New Guinea, and Timor-Leste. I am not sure exactly how big part from the Indo- Pacific they represent and would appreciate comment on this.

Generally, the paper is worth publishing, with a few suggestions for minor changes.

Minor. Methodologically, CEA, per se, is associated with well-acknowledged shortcomings, such as stochastic uncertainty, heterogeneity and treatment stratification, representation uncertainty, misinterpretation of censored data, list not exhaustive. Concerns regarding QALYs have been previously described in many articles, including a 2009 supplement to Value in Health. These limitations are not addressed in the relevant section of the paper.

Minor. Incremental net monetary benefit (INMB) can be presented as an alternative to the ICER. The INMB uses the WTP threshold to convert the QALY into a monetary value. Would the authors consider inclusion of INMB or at least comment its absence?

Minor. Authors are encouraged to elaborate a bit more about the “antivirals”. Indeed, Pfizer is mentioned /Paxlovid?/, are there other/s? It is important to avoid drugs subject to off- label use as well as to note the substantial price differences observed in the access provided during the pandemic period on a country-to-country basis.

Minor. In the PSA authors mentioned 1 000 times. Kindly rephrase to 1 000 Monte Carlo simulation, if this you meant.

Minor. I noticed self- citations in references. Authors are encouraged to explain and act on it.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: Yes: Borislav Borissov

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Cost-effectiveness analysis of COVID-19 booster doses and oral antivirals: case studies in the Indo-Pacific

PONE-D-23-34679R3

Dear Dr. Bilgin,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Dominic Luke Thorrington, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for your submission of the modified manuscript. The manuscript will now be accepted for publication.