title: Cost-effectiveness of vaccination against meningococcal B among Dutch infants: Crucial impact of changes in incidence.
abstract: OBJECTIVE
  Recently, a vaccine with the capacity to protect against serogroup B meningococcal (MenB) disease received a positive opinion of the European Medicines Agency. Previously, such a vaccine was estimated to be cost-effective. However, since then, the MenB disease incidence has declined drastically in the Netherlands. Therefore, we re-assessed the potential incremental cost-effectiveness ratio (ICER) of vaccinating infants in the Netherlands with a MenB vaccine.
  
  
  RESULTS
  Routine infant vaccination (2, 3, 4+11 mo) could prevent 39 cases of MenB disease in a single birth cohort, corresponding to a total gain of 133 quality-adjusted life years (QALYs). However, this strategy is unlikely to be cost-effective if the vaccine costs €40 per dose (€243,778 per QALY). At a disease incidence of 5.7 per 100,000 person-years or a vaccine price of €10 per dose including administration costs, the ICER becomes more acceptable and remains below a threshold of €50,000 per QALY.
  
  
  METHODS
  A cohort of 185,000 Dutch newborns was followed in a Markov model to compare routine vaccination against MenB disease with no vaccination. The ICER was estimated for different disease incidences. The study was performed from a societal perspective.
  
  
  CONCLUSIONS
  At the current low level of disease incidence, introduction of routine infant vaccination, following a 2, 3, 4+11 mo schedule, against MenB disease is unlikely cost-effective in the Netherlands. If the MenB disease incidence increases or the vaccine price is substantially lower than €40, routine infant vaccination has the potential to be cost-effective.
authors: Unit of PharmacoEpidemiology and PharmacoEconomics (PE); Department of Pharmacy; University of Groningen; Groningen, the Netherlands.
authors: Koen B
authors: KB
authors: Pouwels
authors: Eelko
authors: E
authors: Hak
authors: Arie
authors: A
authors: van der Ende
authors: Hannah
authors: H
authors: Christensen
authors: Germie P J M
authors: GP
authors: van den Dobbelsteen
authors: Maarten J
authors: MJ
authors: Postma
mesh_terms: D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008589:Meningococcal Infections / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D038541:Neisseria meningitidis, Serogroup B / Q000276:immunology*; D009426:Netherlands / Q000453:epidemiology; D014611:Vaccination / Q000191:economics* / Q000379:methods*
chemical_list: D022401:Meningococcal Vaccines
keywords: cost-effectiveness; disease incidence; infants; meningococcal B; vaccine