title: Economic evaluation of meningococcal serogroup B childhood vaccination in Ontario, Canada.
abstract: OBJECTIVE
  Invasive Neisseria meningitidis serogroup B (MenB) disease is a low incidence but severe infection (mean annual incidence 0.19/100,000/year, case fatality 11%, major long-term sequelae 10%) in Ontario, Canada. This study assesses the cost-effectiveness of a novel MenB vaccine from the Ontario healthcare payer perspective.
  
  
  METHODS
  A Markov cohort model of invasive MenB disease based on high quality local data and data from the literature was developed. A 4-dose vaccination schedule, 97% coverage, 90% effectiveness, 66% strain coverage, 10-year duration of protection, and vaccine cost of C$75/dose were assumed. A hypothetical Ontario birth cohort (n=150,000) was simulated to estimate expected lifetime health outcomes, quality-adjusted life years (QALYs), and costs, discounted at 5%.
  
  
  RESULTS
  A MenB infant vaccination program is expected to prevent 4.6 invasive MenB disease cases over the lifetime of an Ontario birth cohort, equivalent to 10 QALYs gained. The estimated program cost of C$46.6 million per cohort (including C$318,383 for treatment of vaccine-associated adverse events) were not offset by healthcare cost savings of C$150,522 from preventing MenB cases, resulting in an incremental cost of C$4.76 million per QALY gained. Sensitivity analyses showed the findings to be robust.
  
  
  CONCLUSIONS
  An infant MenB vaccination program significantly exceeds commonly used cost-effectiveness thresholds and thus is unlikely to be considered economically attractive in Ontario and comparable jurisdictions.
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6 Toronto, Ontario, Canada. Electronic address: thihonganh.tu@utoronto.ca.
authors.forename: Hong Anh T
authors.initials: HA
authors.lastname: Tu
authors.affiliation: Public Health Ontario, 480 University Avenue Suite 300, M5G 1V2 Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street 6F, M5T 3M7 Toronto, Ontario, Canada. Electronic address: shelley.deeks@oahpp.ca.
authors.forename: Shelley L
authors.initials: SL
authors.lastname: Deeks
authors.affiliation: Division of Infectious Diseases, Hospital for Sick Children, 555 University Avenue, M5G 1X8 Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue Room 1436D, M5G 1X8 Toronto, Ontario, Canada. Electronic address: shaun.morris@sickkids.ca.
authors.forename: Shaun K
authors.initials: SK
authors.lastname: Morris
authors.affiliation: Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, M5B 1T8 Toronto, Ontario, Canada. Electronic address: lisa.strifler@smh.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Strifler
authors.affiliation: Public Health Ontario, 480 University Avenue Suite 300, M5G 1V2 Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street 6F, M5T 3M7 Toronto, Ontario, Canada. Electronic address: natasha.crowcroft@oahpp.ca.
authors.forename: Natasha
authors.initials: N
authors.lastname: Crowcroft
authors.affiliation: Public Health Ontario, 480 University Avenue Suite 300, M5G 1V2 Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Circle, M5S 1A1 Toronto, Ontario, Canada. Electronic address: frances.jamieson@oahpp.ca.
authors.forename: Frances B
authors.initials: FB
authors.lastname: Jamieson
authors.affiliation: Public Health Ontario, 480 University Avenue Suite 300, M5G 1V2 Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street 6F, M5T 3M7 Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue Room G1 06, M4N 3M5 Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, Ontario, Canada; University Health Network, 190 Elizabeth Street, M5G 2C4 Toronto, Ontario, Canada. Electronic address: jeff.kwong@utoronto.ca.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Kwong
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6 Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, 144 College Street 6F, M5S 3M2 Toronto, Ontario, Canada. Electronic address: peter.coyte@utoronto.ca.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Coyte
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6 Toronto, Ontario, Canada; University Health Network, 190 Elizabeth Street, M5G 2C4 Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, 144 College Street 6F, M5S 3M2 Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, 144 College Street, M5S 3M2 Toronto, Ontario, Canada. Electronic address: murray.krahn@theta.utoronto.ca.
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6 Toronto, Ontario, Canada; Public Health Ontario, 480 University Avenue Suite 300, M5G 1V2 Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue Room G1 06, M4N 3M5 Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, 144 College Street 6F, M5S 3M2 Toronto, Ontario, Canada. Electronic address: beate.sander@oahpp.ca.
authors.forename: Beate
authors.initials: B
authors.lastname: Sander
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007223:Infant; D008390:Markov Chains; D008589:Meningococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000191:economics*; D038541:Neisseria meningitidis, Serogroup B; D009864:Ontario / Q000453:epidemiology; D019057:Quality-Adjusted Life Years
chemical_list: D022401:Meningococcal Vaccines
keywords: Communicable diseases; Cost and cost analysis; Economics; Neisseria meningitidis; Serogroup B; Vaccines