title: Re-evaluating cost effectiveness of universal meningitis vaccination (Bexsero) in England: modelling study.
abstract: OBJECTIVE
  To use mathematical and economic models to predict the epidemiological and economic impact of vaccination with Bexsero, designed to protect against group B meningococcal disease, to help inform vaccine policy in the United Kingdom.
  
  
  METHODS
  Modelling study.
  
  
  METHODS
  England.
  
  
  METHODS
  People aged 0-99.
  
  
  METHODS
  Incremental impact of introductory vaccine strategies simulated with a transmission dynamic model of meningococcal infection and vaccination including potential herd effects. Model parameters included recent evidence on the vaccine characteristics, disease burden, costs of care, litigation costs, and loss of quality of life from disease, including impacts on family and network members. The health impact of vaccination was assessed through cases averted and quality adjusted life years (QALYs) gained.
  
  
  METHODS
  Cases averted and cost per QALY gained through vaccination; programmes were deemed cost effective against a willingness to pay of £20,000 (€25,420, $32,677) per QALY gained from an NHS and personal and social services perspective.
  
  
  RESULTS
  In the short term, case reduction is greatest with routine infant immunisation (26.3% of cases averted in the first five years). This strategy could be cost effective at £3 (€3.8, $4.9) a vaccine dose, given several favourable assumptions and the use of a quality of life adjustment factor. If the vaccine can disrupt meningococcal transmission more cases are prevented in the long term with an infant and adolescent combined programme (51.8% after 30 years), which could be cost effective at £4 a vaccine dose. Assuming the vaccine reduces acquisition by 30%, adolescent vaccination alone is the most favourable strategy economically, but takes more than 20 years to substantially reduce the number of cases.
  
  
  CONCLUSIONS
  Routine infant vaccination is the most effective short term strategy and could be cost effective with a low vaccine price. Critically, if the vaccine reduces carriage acquisition in teenagers, the combination of infant and adolescent vaccination could result in substantial long term reductions in cases and be cost effective with competitive vaccine pricing.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK hannah.christensen@bristol.ac.uk.
authors.forename: Hannah
authors.initials: H
authors.lastname: Christensen
authors.affiliation: Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK.
authors.forename: Caroline L
authors.initials: CL
authors.lastname: Trotter
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.affiliation: London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors.forename: W John
authors.initials: WJ
authors.lastname: Edmunds
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004739:England; D006801:Humans; D007223:Infant; D032541:Mass Vaccination / Q000191:economics*; D008585:Meningitis, Meningococcal / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D055815:Young Adult
chemical_list: C570015:4CMenB vaccine; D022401:Meningococcal Vaccines