The cost-effectiveness of alternative vaccination strategies for polyvalent meningococcal vaccines in Burkina Faso: A transmission dynamic modeling study.
Kristiansen, Paul A
LaForce, F Marc
Public Library of Science (PLoS)
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Yaesoubi, R., Trotter, C., Colijn, C., Yaesoubi, M., Colombini, A., Resch, S., Kristiansen, P. A., et al. (2018). The cost-effectiveness of alternative vaccination strategies for polyvalent meningococcal vaccines in Burkina Faso: A transmission dynamic modeling study.. PLoS medicine, 15 (1), e1002495. https://doi.org/10.1371/journal.pmed.1002495
Background: The introduction of a conjugate vaccine for serogroup A Neisseria meningitidis has dramatically reduced disease in the African meningitis belt. In this context, important questions remain about the performance of different vaccine policies that target remaining serogroups. Here we estimate the health impact and cost associated with several alternative vaccination policies in Burkina Faso. Methods and Findings: We developed and calibrated a mathematical model of meningococcal transmission to project the disability-adjusted life-years (DALYs) averted and costs associated with the current “Base” policy (serogroup A conjugate vaccination at 9 months, as part of the Expanded Program on Immunization (EPI), plus district-specific reactive vaccination campaigns using polyvalent meningococcal polysaccharide (PMP) vaccine in response to outbreaks) and three alternative policies: 1) “Base Prime”: novel polyvalent meningococcal conjugate (PMC) vaccine replaces the serogroup A conjugate in EPI and is also used in reactive campaigns; 2) “Prevention 1”: PMC used in EPI and in a nationwide catch-up campaign for 1-18 year olds; and 3) “Prevention 2”: Prevention 1 except the nationwide campaign includes individuals up to 29 years old. Over a 30-year simulation period, Prevention 2 would avert 78% of the meningococcal cases (95% prediction interval: 63-90%) expected under the Base policy if serogroup A is not replaced by remaining serogroups after elimination, and would avert 87% (77-93%) of meningococcal cases if complete strain replacement occurs. Compared to the Base policy and at the MPC vaccine price of $4 per dose, strategies that use PMC vaccine (i.e. Base Prime, and Prevention 1 and 2) are expected to be cost saving if strain replacement occurs, and would cost $51 (−$236, $490), $188 (−$97, $626), and $246 (−$53, $703) per DALY averted if strain replacement does not occur. An important potential limitation of our study is the simplifying assumption that all circulating meningococcal serogroups can be aggregated into a single group; while this assumption is critical for model tractability, it would compromise the insights derived from our model if the effectiveness of the vaccine differs markedly between serogroups or if there are complex between-serogroup interactions that influence the frequency and magnitude of future meningitis epidemics. Conclusions: Our results suggest that a vaccination strategy that includes a catch-up nationwide immunization campaign in young adults with a PMC vaccine and the addition of this new vaccine into EPI is cost-effective and would avert a substantial portion of meningococcal cases expected under the current World Health Organization recommended strategy of reactive vaccination. This analysis is limited to Burkina Faso and assumes that polyvalent vaccines offer equal protection against all meningococcal serogroups; further studies are needed to evaluate the robustness of this assumption and applicability for other countries in the meningitis belt.
Meningococcal Vaccines, Vaccines, Conjugate, Vaccination, Models, Theoretical, Health Policy, Immunization Programs, Cost-Benefit Analysis, Burkina Faso
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External DOI: https://doi.org/10.1371/journal.pmed.1002495
This record's URL: https://www.repository.cam.ac.uk/handle/1810/273587
Attribution 4.0 International
Licence URL: http://creativecommons.org/licenses/by/4.0/
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