Abstract
BackgroundIn 2002, vaccination with a serogroup C meningococcal conjugate vaccine (MenC) was introduced in the Netherlands for all children aged 14 months. Despite its success, herd immunity may wane over time. Recently, a serogroup A,C,W135,Y meningococcal conjugate vaccine (MenACWY) was licensed for use in subjects of 12 months of age and above.ObjectivesTo evaluate the cost-effectiveness of meningococcal vaccination at 14 months and an additional vaccination at the age of 12 years, both with the MenACWY vaccine.MethodsA decision analysis cohort model, with 185,000 Dutch newborns, was used to evaluate the cost-effectiveness of different immunization strategies. For strategies including a vaccination at 12 years of age, an additional cohort with adolescents aged 12 years was followed. The incremental cost-effectiveness ratio (ICER) was estimated for the current disease incidence and for a scenario when herd immunity is lost.ResultsVaccination with MenACWY at 14 months is cost-saving. Vaccinating with MenACWY at 14 months and at 12 years would prevent 7 additional cases of meningococcal serogroup A,C,W135,Y disease in the birth cohort and adolescent cohort followed for 99 years compared to the current vaccine schedule of a single vaccination with MenC at 14 months. With the current incidence, this strategy resulted in an ICER of €635,334 per quality adjusted life year. When serogroup C disease incidence returns to pre-vaccination levels due to a loss of vaccine-induced herd-immunity, vaccination with MenACWY at 14 months and at 12 years would be cost-saving.ConclusionsRoutine vaccination with MenACWY is cost-saving. With the current epidemiology, a booster-dose with MenACWY is not likely cost-effective. When herd immunity is lost, a booster-dose has the potential of being cost-effective. A dynamic model should be developed for more precise estimation of the cost-effectiveness of the prevention of disappearance of herd immunity.
Highlights
Neisseria meningitidis is an important cause of bacterial meningitis and septicaemia worldwide [1,2]
Vaccinating with MenACWY at 14 months and at 12 years would prevent 7 additional cases of meningococcal serogroup A,C,W135,Y disease in the birth cohort and adolescent cohort followed for 99 years compared to the current vaccine schedule of a single vaccination with meningococcal conjugate vaccine (MenC) at 14 months
Base-case Vaccinating with MenACWY at 14 months would avoid 1 additional case of meningococcal serogroup A,W135,Y disease for the birth cohort followed for 99 years, corresponding to a gain of 2.9 quality adjusted life years (QALYs), and was estimated to be cost-saving
Summary
Neisseria meningitidis (the meningococcus) is an important cause of bacterial meningitis and septicaemia worldwide [1,2]. In the Netherlands, routine vaccination at the age of 14 months with a meningococcal serogroup C conjugate (MenC) vaccine was implemented in the National Immunization Program (NIP) after a meningococcal serogroup C disease outbreak in 2000 and 2001. This implementation was accompanied by a catch-up program for all children and adolescents aged 1 to 18 years. The decreased carriage of serogroup C meningococci has led to a reduced transmission of the bacterium whereby unvaccinated individuals are protected This herd immunity effect might be partly the reason for the decreased incidence of serogroup C disease in the Netherlands [8]. A serogroup A,C,W135,Y meningococcal conjugate vaccine (MenACWY) was licensed for use in subjects of 12 months of age and above
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