title: Meningococcal serogroup A, C, W₁₃₅ and Y conjugated vaccine: a cost-effectiveness analysis in the Netherlands.
abstract: BACKGROUND
  In 2002, vaccination with a serogroup C meningococcal conjugate vaccine (MenC) was introduced in the Netherlands for all children aged 14 months. Despite its success, herd immunity may wane over time. Recently, a serogroup A,C,W135,Y meningococcal conjugate vaccine (MenACWY) was licensed for use in subjects of 12 months of age and above.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of meningococcal vaccination at 14 months and an additional vaccination at the age of 12 years, both with the MenACWY vaccine.
  
  
  METHODS
  A decision analysis cohort model, with 185,000 Dutch newborns, was used to evaluate the cost-effectiveness of different immunization strategies. For strategies including a vaccination at 12 years of age, an additional cohort with adolescents aged 12 years was followed. The incremental cost-effectiveness ratio (ICER) was estimated for the current disease incidence and for a scenario when herd immunity is lost.
  
  
  RESULTS
  Vaccination with MenACWY at 14 months is cost-saving. Vaccinating with MenACWY at 14 months and at 12 years would prevent 7 additional cases of meningococcal serogroup A,C,W135,Y disease in the birth cohort and adolescent cohort followed for 99 years compared to the current vaccine schedule of a single vaccination with MenC at 14 months. With the current incidence, this strategy resulted in an ICER of €635,334 per quality adjusted life year. When serogroup C disease incidence returns to pre-vaccination levels due to a loss of vaccine-induced herd-immunity, vaccination with MenACWY at 14 months and at 12 years would be cost-saving.
  
  
  CONCLUSIONS
  Routine vaccination with MenACWY is cost-saving. With the current epidemiology, a booster-dose with MenACWY is not likely cost-effective. When herd immunity is lost, a booster-dose has the potential of being cost-effective. A dynamic model should be developed for more precise estimation of the cost-effectiveness of the prevention of disappearance of herd immunity.
authors.affiliation: Unit of PharmacoEpidemiology and PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
authors.forename: Hiltsje
authors.initials: H
authors.lastname: Hepkema
authors.forename: Koen B
authors.initials: KB
authors.lastname: Pouwels
authors.forename: Arie
authors.initials: A
authors.lastname: van der Ende
authors.forename: Tjalke A
authors.initials: TA
authors.lastname: Westra
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
mesh_terms: D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006801:Humans; D032521:Immunity, Herd / Q000276:immunology; D007117:Immunization, Secondary / Q000191:economics; D007223:Infant; D008585:Meningitis, Meningococcal / Q000453:epidemiology / Q000517:prevention & control; D022401:Meningococcal Vaccines / Q000191:economics*; D018803:Models, Economic; D009345:Neisseria meningitidis / Q000145:classification / Q000276:immunology; D009426:Netherlands; D014611:Vaccination / Q000191:economics; D018074:Vaccines, Conjugate
chemical_list: D022401:Meningococcal Vaccines; D018074:Vaccines, Conjugate