Cost-effectiveness of alternate strategies for childhood immunization against meningococcal disease with monovalent and quadrivalent conjugate vaccines in Canada

Thomas E Delea,Dion Neame,Evelyn Forget,Joanne M Langley,Fabián P Alvarez,Ayman Chit,Derek Weycker,Mark Atwood,Caroline L Trotter

doi:10.1371/journal.pone.0175721

Abstract

BackgroundPublic health programs to prevent invasive meningococcal disease (IMD) with monovalent serogroup C meningococcal conjugate vaccine (MCV-C) and quadrivalent meningococcal conjugate vaccines (MCV-4) in infancy and adolescence vary across Canadian provinces. This study evaluated the cost-effectiveness of various vaccination strategies against IMD using current and anticipated future pricing and recent epidemiology.MethodsA cohort model was developed to estimate the clinical burden and costs (CAN$2014) of IMD in the Canadian population over a 100-year time horizon for three strategies: (1) MCV-C in infants and adolescents (MCV-C/C); (2) MCV-C in infants and MCV-4 in adolescents (MCV-C/4); and (3) MCV-4 in infants (2 doses) and adolescents (MCV-4/4). The source for IMD incidence was Canadian surveillance data. The effectiveness of MCV-C was based on published literature. The effectiveness of MCV-4 against all vaccination regimens was assumed to be the same as for MCV-C regimens against serogroup C. Herd effects were estimated by calibration to estimates reported in prior analyses. Costs were from published sources. Vaccines prices were projected to decline over time reflecting historical procurement trends.ResultsOver the modeling horizon there are a projected 11,438 IMD cases and 1,195 IMD deaths with MCV-C/C; expected total costs are $597.5 million. MCV-C/4 is projected to reduce cases of IMD by 1,826 (16%) and IMD deaths by 161 (13%). Vaccination costs are increased by $32 million but direct and indirect IMD costs are projected to be reduced by $46 million. MCV-C/4 is therefore dominant vs. MCV-C/C in the base case. Cost-effectiveness of MCV-4/4 was $111,286 per QALY gained versus MCV-C/4 (2575/206 IMD cases/deaths prevented; incremental costs $68 million).ConclusionsIf historical trends in Canadian vaccines prices continue, use of MCV-4 instead of MCV-C in adolescents may be cost-effective. From an economic perspective, switching to MCV-4 as the adolescent booster should be considered.

Highlights

Invasive meningococcal disease (IMD) is a life-threatening illness caused by the bacterium Neisseria meningitidis, and occurs when bacteria spread to the meninges, the bloodstream, or both
Sanofi Pasteur was provided a review of the study research plan and study manuscript; model development and estimation, analyses, and all final decisions related to analytics and the manuscript were made by study authors
life years (LYs) and quality-adjusted life years (QALYs) lost due to invasive meningococcal disease (IMD) would be 36,612 and 30,122, respectively (Table 2)

Summary

Introduction

Invasive meningococcal disease (IMD) is a life-threatening illness caused by the bacterium Neisseria meningitidis, and occurs when bacteria spread to the meninges (the membranes enveloping the central nervous system), the bloodstream, or both. Between 2001 and 2005, almost all Canadian provinces and territories except Nunavut introduced monovalent conjugate meningococcal vaccines against serogroup C (MCV-C) into the routine immunization schedule. The use of these vaccines has helped control illness due to that serogroup [2]. Public health programs to prevent invasive meningococcal disease (IMD) with monovalent serogroup C meningococcal conjugate vaccine (MCV-C) and quadrivalent meningococcal conjugate vaccines (MCV-4) in infancy and adolescence vary across Canadian provinces. This study evaluated the cost-effectiveness of various vaccination strategies against IMD using current and anticipated future pricing and recent epidemiology

Methods

Results

Conclusion