Introduction: despite its low incidence in France, invasive serogroup B meningococcal disease remains a public health concern. A new vaccine against the disease, Bexsero®, has been licensed in the EU. We studied the epidemiological impact and cost-effectiveness of routine vaccination using Bexsero® in order to inform the decision-making process regarding its potential inclusion in the vaccination schedule. Methods: a multi-generational Markov model was used. Time horizon was set to 100 years. Five vaccination strategies were evaluated: infants at 3, 5, 6 and 13 months, toddlers at 13, 15 and 27 months and adolescents at 15 years provided 2 doses one month apart. A booster dose at 15 years old and a catch-up for 15 years old subjects during the first 15 years of the programme were added to the infant and toddler strategies. Costs per QALY gained were computed from a restricted societal perspective including direct costs only. Herd immunity was simulated in an alternative base-case scenario and sensitivity analyses. Results: in the base-case analysis with all cohorts vaccinated, at EUR40 per vaccine dose, routine infant vaccination would provide the lowest cost per QALY gained (EUR380,973) despite only preventing 18% of cases. Under the assumption of herd immunity, the adolescent vaccination would provide the lowest cost per QALY gained (EUR135,902) preventing 24% of cases. Infant vaccination with a late booster and catch-up would prevent 51% of cases with a cost of EUR188,511 per QALY gained. Conclusions: given current meningococcal epidemiology in France and the available data on the protection provided by Bexsero®, our modelling work showed that routine vaccination against serogroup B meningococcal disease is not cost-effective.
Auteur : Lecocq H, Parent du Chatelet I, Taha MK, Levy Bruhl D, Dervaux B
Vaccine, 2016, p. 11 p.