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Sevilla JP, Tortorice D, Kantor D, Regan J, Meszaros KH, Beck EC, Begum N, Bloom DE. Lifecycle model-based evaluation of infant 4CMenB vaccination in the UK. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:1133-1146. [PMID: 38182698 PMCID: PMC11377635 DOI: 10.1007/s10198-023-01654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/22/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES Invasive meningococcal disease, an uncommon but severe disease, imposes catastrophic health and economic burdens. Cost-utility analysis (CUA) assumes separability in lifetime health and economic variables and cannot capture the full value of preventing such burdens. We overcome these limitations with a retrospective societal perspective cost-benefit analysis (CBA) of meningococcal serogroup B vaccination (4CMenB) of one infant cohort in the United Kingdom using a health-augmented lifecycle model (HALM) incorporating health's interactions with consumption, earnings, non-market time and financial risk. METHODS We used a static Markov model of vaccination's health impact and an HALM to estimate the private willingness to pay (PWTP) for the intrinsic and instrumental value of health under perfect capital markets, financial risk protection in the absence of insurance against permanent disability, parental spillovers, and acute phase disability. We estimated social WTP (SWTP) incorporating social severity preferences. We estimated rates of return that inform health payer reimbursement decisions, finance ministry budgeting decisions, and legislature taxation decisions. An expert Advisory Board investigated the validity of applying the HALM to infant 4CMenB. RESULTS The PWTP for a 2 + 1 vaccination schedule is £395, comprising £166 of disability insurance value, £79 of positive parental spillover value, £28 in the value of averting acute phase disability, and £122 in residual intrinsic and instrumental value of health. SWTP is £969. CONCLUSIONS HALM-based CBA provides an empirically richer, more utility-theoretically grounded approach to vaccine evaluation than CUA, demonstrating good value for money for legislatures (based on private values) and for all decision-makers (based on social values).
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Affiliation(s)
- J P Sevilla
- Data for Decisions (DfD) LLC, 681 Main Street, Suite 3-37, Waltham, MA, 02457, USA.
| | - Daniel Tortorice
- Data for Decisions (DfD) LLC, 681 Main Street, Suite 3-37, Waltham, MA, 02457, USA
| | - David Kantor
- Data for Decisions (DfD) LLC, 681 Main Street, Suite 3-37, Waltham, MA, 02457, USA
| | - John Regan
- Data for Decisions (DfD) LLC, 681 Main Street, Suite 3-37, Waltham, MA, 02457, USA
| | | | | | | | - David E Bloom
- Data for Decisions (DfD) LLC, 681 Main Street, Suite 3-37, Waltham, MA, 02457, USA
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Gaudelus J, Cohen R, Stahl JP, Denigot M, Gelin P, Gruber A, Mediouni L, Martinot A. Vaccination of teenagers in France over a 10-year period (2012-2021). Infect Dis Now 2024; 54:104952. [PMID: 38950884 DOI: 10.1016/j.idnow.2024.104952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/01/2024] [Accepted: 06/27/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES The objectives were to assess trends over the past 10 years in vaccination coverage rates (VCR) among adolescents in France aged 14-15 years, factors influencing decisions to vaccinate, and mothers' opinions on adolescent vaccination. PATIENTS AND METHODS The 'Vaccinoscopie' internet survey is completed each year by mothers of adolescents, with questions about vaccinations received by their children, and their attitudes and barriers to vaccination. The 2012 to 2021 surveys were analyzed in this study, including data from 1500 adolescents in 2012 and 1000 adolescents each year from 2013 to 2021. RESULTS None of the adolescent VCR targets were met, despite significant increases since 2012 for vaccines with the lowest coverage rates and vaccines with high but insufficient coverage i.e., meningococcal C (28.7% to 60.8%), HPV in girls (14.2% to 40.8%), hepatitis B (31.6% to 47.3%) and pertussis (76.3% to 91.0%). Physicians remained the primary source of vaccination information for 90.4% of mothers, and their advice had a real impact on improving VCRs. Adolescents were increasingly involved (40.1%) in decisions about vaccination. Depending on the vaccine, over 80% of mothers currently consider adolescent vaccination as useful or essential. Since 2017, they also feel better informed. CONCLUSIONS Low and under-target VCRs put adolescents at risk of severe disease, and do not enable herd immunity or reduced transmission to other vulnerable age groups to be accomplished. Healthcare professionals must take every opportunity to check adolescents' vaccination status and recommend catch-up vaccines where applicable. Vaccination in schools should be considered.
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Affiliation(s)
- J Gaudelus
- Université de Paris-XIII, Bobigny, France
| | - R Cohen
- CHI Créteil, Créteil, France
| | - J P Stahl
- Université Grenoble Alpes, Grenoble, France
| | - M Denigot
- IDM Families, Issy-les-Moulineaux, France
| | - P Gelin
- IDM Families, Issy-les-Moulineaux, France
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Marshall GS, McCormick ZL, Johns JS, Verduzco-Gutierrez M, Herrera-Restrepo O, Harrison LH. Understanding the Sequelae of Invasive Meningococcal Disease in the United States. Infect Dis Ther 2024:10.1007/s40121-024-01026-w. [PMID: 39269567 DOI: 10.1007/s40121-024-01026-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/26/2024] [Indexed: 09/15/2024] Open
Abstract
Invasive meningococcal disease (IMD) is an uncommon but serious and potentially fatal condition that can result in reduced life expectancy and a broad spectrum of sequelae, many of which may be lifelong and devastating for those who survive the acute disease period. In the United States of America (USA), vaccination is available against the five meningococcal serogroups (A, B, C, W, and Y), but meningococcal vaccination rates among healthy USA adolescents and individuals at high risk because of medical conditions are low, rendering them vulnerable to IMD and its sequelae. Despite the severity of the disease, the clinical impact and rates of IMD sequelae in the USA are poorly understood, as USA-specific data are limited, and the methodology of existing research is heterogenous. This commentary presents clinical experts' perspectives on IMD sequelae based on the available published evidence and direct clinical experience. Among sequelae previously identified in a global systematic literature review, 16 conditions were considered as related to IMD by the present authors. These sequelae include short- and long-term physical, neurological, and emotional consequences that impose a substantial humanistic burden on survivors and their caregivers and result in considerable healthcare and societal costs. This commentary highlights existing knowledge gaps concerning IMD sequelae, including the unclear relationship between IMD and mental health disorders, the contribution of sequelae to the disease burden, prevalence of late-onset sequelae among survivors, and timing of the development of sequelae in different age groups. Addressing these knowledge gaps can inform decisions regarding clinical management in the post-acute period and help quantify the impact of prevention through meningococcal vaccination.
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Affiliation(s)
- Gary S Marshall
- Norton Children's and the University of Louisville School of Medicine, Louisville, KY, USA
| | | | | | | | | | - Lee H Harrison
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Ahn SJ. Real-World Research on Retinal Diseases Using Health Claims Database: A Narrative Review. Diagnostics (Basel) 2024; 14:1568. [PMID: 39061705 PMCID: PMC11276298 DOI: 10.3390/diagnostics14141568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Real-world data (RWD) has emerged as a crucial component in understanding and improving patient outcomes across various medical conditions, including retinal diseases. Health claims databases, generated from healthcare reimbursement claims, offer a comprehensive source of RWD, providing insights into patient outcomes, healthcare utilization, and treatment effectiveness. However, the use of these databases for research also presents unique challenges. This narrative review explores the role of real-world research on retinal diseases using health claims databases, highlighting their advantages, limitations, and potential contributions to advancing our understanding and management of the diseases. The review examines the applications of health claims databases in retinal disease research, including epidemiological studies, comparative effectiveness and safety analyses, economic burden assessments, and evaluations of patient outcomes and quality of care. Previous findings demonstrate the value of these databases in generating prevalence and incidence estimates, identifying risk factors and predictors, evaluating treatment effectiveness and safety, and understanding healthcare utilization patterns and costs associated with retinal diseases. Despite their strengths, health claims databases face challenges related to data limitations, biases, privacy concerns, and methodological issues. Accordingly, the review also explores future directions and opportunities, including advancements in data collection and analysis, integration with electronic health records, collaborative research networks and consortia, and the evolving regulatory landscape. These developments are expected to enhance the utility of health claims databases for retinal disease research, resulting in more comprehensive and impactful findings across diverse retinal disorders and robust real-world insights from a large population.
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Affiliation(s)
- Seong Joon Ahn
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
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de Pouvourville G, Breau-Brunel M, Loncle-Provot V, Beck E, Gaugain L, Nachbaur G, Pribil C. Public Health Impact and Cost-Effectiveness Analysis of 4-Component Meningococcal Serotype B Vaccination for Infants in France. PHARMACOECONOMICS - OPEN 2024; 8:539-557. [PMID: 38780884 PMCID: PMC11252096 DOI: 10.1007/s41669-024-00488-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND AND OBJECTIVES In France, meningococcal serogroup B (MenB) is the most common serogroup causing invasive meningococcal disease (IMD) in infants and young children. Our objective was to illustrate the impact of model choices on health outcomes and the cost-effectiveness of infant vaccination with the multicomponent meningococcal serogroup B vaccine (4CMenB) versus no vaccine in France. METHODS A previously published dynamic transmission-based cost-effectiveness model was adapted for the French context using updated, French-specific demographic, epidemiological, and cost data. IMD incidence and long-term sequelae were derived through analysis of French healthcare and surveillance databases. A collective perspective over a 100-year time horizon was adopted, with a discount rate of 2.5%, reduced to 1.5% after the first 30 years. Deterministic and probabilistic sensitivity and scenario analyses were performed. RESULTS In the base case analysis, infant vaccination with 4CMenB avoided 3101 MenB IMD cases in infants aged < 1 year (- 54%) and 6845 cases in all age groups (- 21%). The estimated incremental cost-effectiveness ratio was €316,272/quality-adjusted life-year (QALY) but was highly sensitive to the types of sequelae included, MenB incidence, vaccine effectiveness parameters, and consideration of life-expectancy in IMD survivors (range: €65,272/QALY to €493,218/QALY). CONCLUSIONS Using economic models compliant with French methodology guidelines, 4CMenB does not seem cost-effective; however, results are sensitive to model choices and 4CMenB immunization is an effective strategy to prevent MenB IMD cases and to improve quality of life and economic burden associated with MenB IMD treatment, especially with regard to long-term sequelae.
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Affiliation(s)
| | | | | | | | | | | | - Céline Pribil
- GSK, 23, rue François Jacob, 92500, Rueil-Malmaison, France.
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6
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Herrera-Restrepo O, Bunniran S, Mond T, Davenport E, Wang J, Sweeney C, Marshall GS. United States Physicians' Knowledge, Attitudes, and Practices Regarding Meningococcal Vaccination for Healthy Adolescents and Young Adults. J Adolesc Health 2024; 74:1131-1138. [PMID: 38363244 DOI: 10.1016/j.jadohealth.2023.11.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 02/17/2024]
Abstract
PURPOSE The United States Advisory Committee on Immunization Practices (ACIP) recommends vaccination against meningococcal serogroups A, C, W, and Y (MenACWY) for all 11-12-year-olds, with a booster dose for 16-year-olds, and against meningococcal serogroup B (MenB) for 16-23-year-olds under shared clinical decision-making (SCDM). However, uptake of the MenB vaccine and the MenACWY booster dose is low. This study investigated United States physicians' knowledge, attitudes, and practices regarding recommending MenB and MenACWY vaccines to non-high-risk older adolescents and young adults. METHODS An online survey was conducted in April-May 2022 among pediatricians, family physicians (FPs), general practitioners (GPs), and internists who had recommended the MenB and/or the MenACWY vaccine(s) to at least one 16-23-year-old in the past year. RESULTS Among 407 participants, 50% correctly identified MenB as the leading cause of meningococcal disease among adolescents and young adults. Furthermore, 46% of physicians (47% of pediatricians, 40% of FPs and GPs, 53% of internists) answered correctly that MenB vaccination is recommended under SCDM, and 82% of physicians (96% of pediatricians, 70% of FPs and GPs, 65% of internists) answered correctly that MenACWY vaccination is routinely recommended. Among MenB-vaccinators, 78% reported having received some training or other information on implementing SCDM, and 65% rated recommending MenB vaccination as very important. DISCUSSION Knowledge gaps, which varied by specialty, were identified regarding meningococcal disease and vaccine recommendations, particularly regarding MenB. Targeted education of physicians may facilitate discussions about MenB vaccination.
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Affiliation(s)
| | - Suvapun Bunniran
- Surveys and Observational Studies, RTI Health Solutions, Research Triangle Park, North Carolina
| | - Tiffany Mond
- US Medical Affairs, Vaccines, GSK, Philadelphia, Pennsylvania
| | - Eric Davenport
- Biostatistics, RTI Health Solutions, Research Triangle Park, North Carolina
| | - Jinyi Wang
- Biostatistics, RTI Health Solutions, Research Triangle Park, North Carolina
| | - Carolyn Sweeney
- Surveys and Observational Studies, RTI Health Solutions, Research Triangle Park, North Carolina
| | - Gary S Marshall
- Pediatrics, Norton Children's and the University of Louisville School of Medicine, Louisville, Kentucky
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Clements DE, Olaiya T, Burman C, Herrera-Restrepo O, Sohn WY, Folaranmi T, Abbing-Karahagopian V, Marshall GS, Conway JH. Past, present, and future policy considerations regarding meningococcal vaccination in the United States. Expert Rev Vaccines 2024; 23:845-861. [PMID: 39230002 DOI: 10.1080/14760584.2024.2397705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/16/2024] [Accepted: 08/24/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION In 2005, the United States Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination against invasive meningococcal disease (IMD) caused by serogroups A, C, W, and Y (MenACWY) for all 11-12-year-olds, as well as 2-10-year-olds at high risk. In 2010, a booster dose was recommended for all 16-year-olds, as well as for high-risk patients every 3-5 years. In 2015, optional (as opposed to routine) vaccination against meningococcal serogroup B (MenB) at the preferred age of 16-18 years was recommended (Category B, later changed to shared clinical decision-making). In 2023, a vaccine (MenABCWY) against the five serogroups primarily responsible for IMD in the U.S. became available. AREAS COVERED This review summarizes the evolution of public policy that led to each milestone vaccine recommendation, reviews epidemiologic data published following the recommendations, and discusses the current state of meningococcal immunization policy. EXPERT OPINION The use of MenABCWY has the potential to consolidate policy, improve coverage rates for the five serogroups, address disparities in vaccination coverage, and simplify vaccine delivery.
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Affiliation(s)
- Diana E Clements
- U.S. Medical and Clinical Affairs, Vaccines, GSK, Philadelphia, PA, USA
| | - Tosin Olaiya
- U.S. Medical and Clinical Affairs, Vaccines, GSK, Philadelphia, PA, USA
| | - Cindy Burman
- U.S. Medical and Clinical Affairs, Vaccines, GSK, Philadelphia, PA, USA
| | | | | | - Temi Folaranmi
- U.S. Medical and Clinical Affairs, Vaccines, GSK, Philadelphia, PA, USA
| | | | - Gary S Marshall
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Norton Children's and the University of Louisville School of Medicine, Louisville, KY, USA
| | - James H Conway
- Department of Pediatrics, The University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA
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Kassianos G, Barasheed O, Abbing-Karahagopian V, Khalaf M, Ozturk S, Banzhoff A, Badur S. Meningococcal B Immunisation in Adults and Potential Broader Immunisation Strategies: A Narrative Review. Infect Dis Ther 2023; 12:2193-2219. [PMID: 37428339 PMCID: PMC10581987 DOI: 10.1007/s40121-023-00836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Recombinant vaccines against invasive meningococcal disease due to Neisseria meningitidis serogroup B (MenB) have shown substantial impact in reducing MenB disease in targeted populations. 4CMenB targets four key N. meningitidis protein antigens; human factor H binding protein (fHbp), Neisserial heparin binding antigen (NHBA), Neisseria adhesin A (NadA) and the porin A protein (PorA P1.4), with one or more of these expressed by most pathogenic MenB strains, while MenB-FHbp targets two distinct fHbp variants. While many countries recommend MenB immunisation in adults considered at high risk due to underlying medical conditions or immunosuppression, there are no recommendations for routine use in the general adult population. We reviewed the burden of MenB in adults, where, while incidence rates remain low (and far lower than in young children < 5 years of age at greatest risk), a substantial proportion of MenB cases (20% or more) is now observed in the adult population; evident in Europe, Australia, and in the United States. We also reviewed immunogenicity data in adults from clinical studies conducted during MenB vaccine development and subsequent post-licensure studies. A 2-dose schedule of 4CMenB generates hSBA titres ≥ 1:4 towards all four key vaccine target antigens in up to 98-100% of subjects. For MenB-FHbp, a ≥ fourfold rise in hSBA titres against the four primary representative test strains was observed in 70-95% of recipients following a 3-dose schedule. While this suggests potential benefits for MenB immunisation if used in adult populations, data are limited (especially for adults > 50 years) and key aspects relating to duration of protection remain unclear. Although a broader adult MenB immunisation policy could provide greater protection of the adult population, additional data are required to support policy decision-making.
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Affiliation(s)
- George Kassianos
- Royal College of General Practitioners, London, UK
- The British Global and Travel Health Association, London, UK
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Gibson E, Ollendorf DA, Simoens S, Bloom DE, Martinón-Torres F, Salisbury D, Severens JL, Toumi M, Molnar D, Meszaros K, Sohn WY, Begum N. Rule of Prevention: a potential framework to evaluate preventive interventions for rare diseases. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2239557. [PMID: 37583879 PMCID: PMC10424616 DOI: 10.1080/20016689.2023.2239557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/19/2023] [Accepted: 07/18/2023] [Indexed: 08/17/2023]
Abstract
Background: The benefits of preventive interventions lack comprehensive evaluation in standard health technology assessments (HTA), particularly for rare and transmissible diseases. Objective: To identify possible considerations for future HTA using analogies between the treatment and prevention of rare diseases. Study design: An Expert panel meeting assessed whether one HTA assessment framework can be applied to assess both rare disease treatments and preventive interventions. Experts also evaluated the range of value elements currently included in HTAs and their applicability to rare, transmissible, and/or preventable diseases. Results: A broad range of value should be considered when assessing rare, transmissible disease prevention. Although standard HTA can be applied to transmissible diseases, the risk of local outbreaks and the need for large-scale prevention programs suggest a modified assessment framework, capable of incorporating prevention-specific value elements in HTAs. A 'Rule of Prevention' framework was proposed to allow broader value considerations anchored to severity, equity, and prevention benefits in decision-making for preventive interventions for rare transmissible diseases. Conclusion: The proposed prevention framework introduces an explicit initial approach to consistently assess rare transmissible diseases, and to incorporate the broader value of preventive interventions compared with treatment.
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Affiliation(s)
| | - Daniel A. Ollendorf
- Institute for Clinical Research and Health Policy Studies (ICRHPS), Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, MA, USA
| | - Steven Simoens
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Federico Martinón-Torres
- Department of Pediatrics, Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago, Santiago de Compostela, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - David Salisbury
- Royal Institute of International Affairs, Chatham House, London, UK
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Epidemiology and Clinical Burden of Meningococcal Disease in France: Scoping Review. J Clin Med 2023; 12:jcm12030849. [PMID: 36769498 PMCID: PMC9917955 DOI: 10.3390/jcm12030849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/14/2023] [Indexed: 01/25/2023] Open
Abstract
Invasive meningococcal disease (IMD) remains a significant health concern due to its unpredictable nature and its rapid progression. Even if occurrence of IMD is strictly monitored by a national surveillance network, no information on long-term sequelae is reported, making it difficult to assess the entire clinical burden of IMD in France. The aim of this scoping review was to analyze the epidemiology and the clinical burden of IMD in France by reporting the main epidemiological parameters, and by describing the clinical consequences and the care pathway of patients. The process of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to the Scoping Reviews guidelines. In France, the incidence of IMD cases has been fluctuating over time, characterized by an overall downward trend linked to a decrease in Sg B cases and the introduction of mandatory vaccination against Sg C. Sg W cases increased in recent years (from 5% to 21% in 2019). The case fatality rate remained constant (6-12.9%). The most frequently reported sequelae were severe neurological disorder, epilepsy, and anxiety. However, data on sequelae and care pathways were scarce. Further research should concentrate on providing robust identification of sequelae and the subsequent impact on quality of life, as well as on the organization of optimal care and support for patients and their families.
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Public Health Impact and Cost-Effectiveness Analysis of Routine Infant 4CMenB Vaccination in Germany to Prevent Serogroup B Invasive Meningococcal Disease. Infect Dis Ther 2021; 11:367-387. [PMID: 34877641 PMCID: PMC8847463 DOI: 10.1007/s40121-021-00573-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Invasive meningococcal disease (IMD) is an uncommon, severe, life-threatening disease primarily affecting infants, with potential lifelong sequelae. Neisseria meningitidis (Nm) serogroup B (MenB) causes most IMD cases in Germany, many of which can be prevented with four-component MenB (4CMenB) vaccination. The potential public health and economic impact of introducing routine 4CMenB infant vaccination in Germany was assessed. Methods A dynamic transmission-based cost-effectiveness model adapted for Germany assessed the impact of infant 4CMenB universal mass vaccination (UMV) versus no vaccination. The model included the latest real-world evidence on vaccine effectiveness, the comprehensive burden of disease on patients (sequelae) and their family (quality of life impact), comprehensive German IMD costs, and vaccination uptake assumptions. Results The largest public health impact was predicted in children: a rapid decline, 5 years after UMV implementation, of 39.9% (34.7%) for MenB (all IMD) cases aged 0–4 years and 42.4% (36.8%) in infants. Over lifetime (100-year time horizon), 4CMenB could prevent 3154 MenB (3303 all IMD) cases, 291 MenB (304 all IMD) deaths and 1370 MenB (1435 all IMD) long-term sequelae. 4CMenB saved 25,878 quality-adjusted life-years (QALYs), at a cost of €188,762 per QALY gained in the base case (societal perspective including lost productivity). Scenarios including potential Nm carriage protection (enabling herd protection) or societal preferences for the prevention of severe diseases led to more cost-effective results, while a scenario excluding IMD impact beyond the patient with increased discounting of vaccination health benefits produced less cost-effective results. Conclusions MenB IMD is a vaccine-preventable disease. This analysis for Germany can inform decision-makers on the potential impact of introducing infant 4CMenB UMV. The program is predicted to rapidly produce health benefits (reduction in child cases, deaths and sequelae) at a cost per QALY to society of around €190,000 (base case), decreasing to around €78,000 when considering societal preferences and IMD underreporting. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00573-w. Invasive meningococcal disease (IMD) is an uncommon but severe infection, usually presenting as meningitis and/or sepsis, caused by the bacteria Neisseria meningitidis. Most cases occur in infants, young children and adolescents. Patients who survive the disease can develop lifelong sequelae, such as physical, neurological and psychological/behavioural problems that impact their quality of life and that of their family/caregivers. This disease can be prevented by vaccination. The use of the four-component meningococcal serogroup B vaccine (4CMenB) in countries like Germany can prevent the most common form of this disease, IMD caused by serogroup B. This study assessed the public health and economic impact of infant vaccination in Germany with 4CMenB. For this, the authors used an economic model that measured the lifetime impact of the disease on patients but also on their families. The model predicted that after 5 years of vaccination, the number of cases and deaths in infants and young children aged 0–4 years would rapidly decrease by almost 40%. Over a long-term horizon of 100 years, this number was predicted to remain stable. Due to the reduced number of cases, vaccination would also result in fewer deaths and patients with sequelae, as well as cost savings for the healthcare system and society due to the reduced loss of productivity. In conclusion, in Germany, IMD caused by serogroup B is preventable through vaccination, and the 4CMenB vaccine in German infants is predicted to rapidly reduce the disease burden, save lives and prevent healthcare costs.
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