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

PLoS One. 2017 May 4;12(5):e0175721. doi: 10.1371/journal.pone.0175721. eCollection 2017.

Abstract

Background: 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: A 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.

Results: Over 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).

Conclusions: If 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.

MeSH terms

  • Adolescent
  • Canada
  • Child
  • Child, Preschool
  • Cohort Studies
  • Humans
  • Infant
  • Meningococcal Vaccines / administration & dosage*

Substances

  • Meningococcal Vaccines

Grants and funding

Funding for this research was provided by Sanofi Pasteur to Policy Analysis Inc. (PAI). Mark Atwood, Thomas Delea, and Derek Weycker are employed by PAI. Ayman Chit, Dion Neame, and Fabián Alvarez are employed by Sanofi Pasteur. J Langley holds the Canadian Institutes of Health Research-GlaxoSmithKline Chair in Pediatric Vaccinology at Dalhousie University, Halifax, Canada. 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. Policy Analysis Inc. (PAI) provided support in the form of salaries for authors TED, DW and MA, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. Sanofi Pasteur provided support in the form of salaries for authors DN, FPA and AC, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.