Cost-Effectiveness of 4CMenB Infant Vaccination in England: A Comprehensive Valuation Considering the Broad Impact of Serogroup B Invasive Meningococcal Disease

Abstract

This cost-effectiveness analysis (CEA) of 4CMenB infant vaccination in England comprehensively considers the broad burden of serogroup B invasive meningococcal disease (MenB IMD), which has not been considered, or was only partially considered in previous CEAs.Methods: A review of previous MenB vaccination CEAs was conducted to identify aspects considered in the evaluation of costs and health outcomes of the disease burden of MenB IMD. To inform the model structure and comprehensive analysis, the aspects were grouped into 5 categories. A stepwise analysis was conducted to analyze the impact of each category, and the more comprehensive consideration of disease burden, on the incremental cost-effectiveness ratio (ICER).Results: MenB IMD incidence decreased by 46.0% in infants and children 0-4 years old within 5 years after introduction of the program. Stepwise inclusion of the 5 disease burden categories to a conventional narrow CEA setting reduced the ICER from £360 595 to £18 645-that is, considering the impact of all 5 categories, 4CMenB infant vaccination is cost-effective at a threshold of £20 000 per QALY gained.Conclusions: When considering comprehensively the MenB IMD burden, 4CMenB infant vaccination can be cost-effective, a finding contrary to previous CEAs. This analysis allows policy decision-makers globally to infer the impact of current disease burden considerations on the cost-effectiveness and the comprehensive assessment necessary for MenB IMD. Although this comprehensive CEA can help inform decision making today, it may be limited in capturing the full disease burden and complex interactions of health and economics of MenB IMD.

Public Health Impact and Cost-Effectiveness Analysis of Routine Infant 4CMenB Vaccination in Germany to Prevent Serogroup B Invasive Meningococcal Disease

“…1 schedule [30] and therefore the model uses these vaccine effectiveness values. This model was previously used in the UK [18], and the impact of 4CMenB using the Portuguese vaccine effectiveness estimates provided comparable vaccine impact results to those observed from real-world data after 3 years of routine 4CMenB infant vaccination [12]. Model vaccine effectiveness against MenB IMD was assumed to be 0% after the first dose (conservative assumption) and 79% after the second and booster doses.…”

Long-Term Mortality and State Financial Support in Invasive Meningococcal Disease—Real-World Data Analysis Using the French National Claims Database (SNIIRAM)

“…Hospitalisation data were used to identify incident IMD cases at their first (index) hospitalisation, after which cases were followed prospectively in the database to identify any long-term IMD complications and sequelae. Predefined potential IMD sequelae [ 18 , 19 ] were identified through their diagnostic codes, medical procedures or treatments performed in inpatient and outpatient settings. No serogroup-specific data on IMD cases were available.…”

Healthcare Resource Consumption and Cost of Invasive Meningococcal Disease in France: A Study of the National Health Insurance Database

“…The data generated in this study could be of use in economic modelling studies to determine the impact of different healthcare policies aimed at improving the prevention or treatment of IMD in France or elsewhere. Such an approach has been followed elsewhere to estimate the cost-effectiveness of anti-meningococcal B vaccination in Italy [ 15 , 30 ] and in England [ 24 ], where this vaccine has been introduced in recent years (Italy, 2017; England, 2015). In particular, the English study also took explicit account of the major impact on costs of management of a broad range of long-term sequelae [ 24 ].…”

“…Such an approach has been followed elsewhere to estimate the cost-effectiveness of anti-meningococcal B vaccination in Italy [ 15 , 30 ] and in England [ 24 ], where this vaccine has been introduced in recent years (Italy, 2017; England, 2015). In particular, the English study also took explicit account of the major impact on costs of management of a broad range of long-term sequelae [ 24 ].…”

“…Potential long-term sequelae of IMD, selected from previous studies [ 21 , 22 ], were identified from hospital discharge summaries by the corresponding ICD-10 or procedure code, or from medication delivery records, using a classification system developed in 2015 by the French national general health insurance fund (see Table S1 in the electronic supplementary material for detail) [ 23 ] and a previously described algorithm for identifying IMD-specific sequelae [ 24 ]. These included immediate and irreversible sequelae, such as amputation, that were identified from hospital discharge records and sequelae appearing and identified after discharge.…”