Epidemiological impact and cost-effectiveness of universal vaccination with Bexsero® to reduce meningococcal group B disease in Germany
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Christensen, H., Irving, T., Koch, J., Trotter, C., Ultsch, B., Weidemann, F., Wichmann, O., & et al. (2016). Epidemiological impact and cost-effectiveness of universal vaccination with Bexsero® to reduce meningococcal group B disease in Germany. Vaccine, 34 3412-3419. https://doi.org/10.1016/j.vaccine.2016.04.004
Bexsero, a new vaccine against serogroup B meningococcal disease (MenB), was licensed in Europe in January 2013. In Germany, Bexsero is recommended for persons at increased risk of invasive meningococcal disease, but not for universal childhood vaccination. To support decision making we adapted the independently developed model for England to the German setting to predict the potential health impact and cost-effectiveness of universal vaccination with Bexsero® against MenB disease. We used both cohort and transmission dynamic mathematical models, the latter allowing for herd effects, to consider the impact of vaccination on individuals aged 0–99 years. Vaccination strategies included infant and adolescent vaccination, alone or in combination, and with one-off catch-up programmes. German specific data were used where possible from routine surveillance data and the literature. We assessed the impact of vaccination through cases averted and quality adjusted life years (QALY) gained and calculated costs per QALY gained. Assuming 65% vaccine uptake and 82% strain coverage, infant vaccination was estimated to prevent 15% (34) of MenB cases over the lifetime of one birth cohort. Including herd effects from vaccination increased the cases averted by infant vaccination to 22%, with an estimated 8461 infants requiring vaccination to prevent one case. In the short term the greatest health benefit is achieved through routine infant vaccination with large-scale catch-up, which could reduce cases by 24.9% after 5 years and 27.9% after 10 years. In the long term (20+ years) policies including routine adolescent vaccination are most favourable if herd effects are assumed. Under base case assumptions with a vaccine list price of €96.96 the incremental cost-effectiveness ratio (ICER) was >€500,000 per QALY for all considered strategies. Given the current very low incidence of MenB disease in Germany, universal vaccination with Bexsero® would prevent only a small absolute number of cases, at a high overall cost.
meningococcal disease, serogroup B, model, cost-effectiveness
This work was supported by the Robert Koch Institute. HC’s work was supported by the National Institute for Health Research [RDA/03/07/014 and PDF-2012-05-245]. This work is produced by the authors under the terms of these research training fellowships issued by the NIHR. HC is a member of the NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol. The views expressed in this publication are those of the authors and not necessarily those of the NHS, The National Institute for Health Research or the Department of Health. The NIHR had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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External DOI: https://doi.org/10.1016/j.vaccine.2016.04.004
This record's URL: https://www.repository.cam.ac.uk/handle/1810/255099
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