Cost-Effectiveness of Alternative Uses of Polyvalent Meningococcal Vaccines in Niger: An Agent-Based Transmission Modeling Study

Abstract

Background. Despite the introduction of an effective serogroup A conjugate vaccine (MenAfriVac™), sporadic epidemics of other Neisseria meningitidis serogroups remain a concern in Africa. Polyvalent meningococcal conjugate (PMC) vaccines may offer alternatives to current strategies that rely on routine infant vaccination with MenAfriVac plus, in the event of an epidemic, district-specific reactive campaigns using polyvalent meningococcal polysaccharide (PMP) vaccines. Methods. We developed an agent-based transmission model of N. meningitidis in Niger to compare the health effects and costs of current vaccination practice and 3 alternatives. Each alternative replaces MenAfriVac in the infant vaccination series with PMC and either replaces PMP with PMC for reactive campaigns or implements a one-time catch up campaign with PMC for children and young adults. Results. Over a 28-year period, replacement of MenAfriVac with PMC in the infant immunization series and of PMP in reactive campaigns would avert 63% of expected cases (95% prediction interval 49%–75%) if elimination of serogroup A is not followed by serogroup replacement. At a PMC price of $4/dose, this would cost $1412 ($81–$3510) per disability-adjusted life-year (DALY) averted. If serogroup replacement occurs, the cost-effectiveness of this strategy improves to $662 (cost-saving, $2473) per DALY averted. Sensitivity analyses accounting for incomplete laboratory confirmation suggest that a catch-up PMC campaign would also meet standard cost-effectiveness thresholds. Limitations. The assumption that polyvalent vaccines offer similar protection against all serogroups is simplifying. Conclusions. The use of PMC vaccines to replace MenAfriVac in routine infant immunization and in district-specific reactive campaigns would have important health benefits and is likely to be cost-effective in Niger. An additional PMC catch-up campaign would also be cost-effective if we account for incomplete laboratory reporting.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Explanation and Elaboration: A Report of the ISPOR CHEERS II Good Practices Task Force

“…Statistical uncertainty associated with economic evaluations undertaken with individual patient data (IPD) can be reflected by reporting confidence intervals or Bayesian credibility intervals of incremental costs and incremental effects. Because confidence or credible intervals can be problematic to estimate and misleading, 141 cost-effectiveness planes and costeffectiveness acceptability curves may be more appropriate Example of Item 17: Analytics and assumptions 134,135 "A summary of . key assumptions around modelling approach [is] in Table 2; .…”

Vaccines to Prevent Meningitis: Historical Perspectives and Future Directions

“…Similarly, compared with a reactive vaccination strategy, prevention strategies using NmCV-A were shown to be significantly cost saving in Burkina Faso [ 93 ]. Such analyses will be important for decision-makers considering whether the higher price of the next generation of meningococcal or pneumococcal vaccines or the price of new vaccines to prevent GBS meningitis are justified by their benefits [ 94 ].…”