title: Epidemiological impact and cost-effectiveness of introducing vaccination against serogroup B meningococcal disease in France.
abstract: BACKGROUND
  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 without herd immunity and with all cohorts vaccinated, at € 40 per vaccine dose, routine infant vaccination would provide the lowest cost per QALY gained (€ 380,973) despite only preventing 18% of cases. Under the assumption of herd immunity, the adolescent vaccination would provide the lowest cost per QALY gained (€ 135,902) preventing 24% of cases. Infant vaccination with a late booster and catch-up would prevent 51% of cases with a cost of € 188,511 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.
authors.affiliation: EA 2694, Lille University School of Medicine, France.
authors.forename: Héloïse
authors.initials: H
authors.lastname: Lecocq
authors.affiliation: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France. Electronic address: i.parent@invs.sante.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Parent du Châtelet
authors.affiliation: Institut Pasteur, National Reference Center for Meningococci, Paris, France.
authors.forename: Muhamed-Kheir
authors.initials: MK
authors.lastname: Taha
authors.affiliation: French Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lévy-Bruhl
authors.affiliation: EA 2694, Lille University School of Medicine, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Dervaux
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005602:France; D006801:Humans; D032521:Immunity, Herd; D007115:Immunization Schedule; D007117:Immunization, Secondary; D007223:Infant; D008390:Markov Chains; D008589:Meningococcal Infections / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000191:economics / Q000627:therapeutic use*; D018803:Models, Economic; D038541:Neisseria meningitidis, Serogroup B; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics*
chemical_list: D022401:Meningococcal Vaccines
keywords: Cost-effectiveness; Meningococcal; Serogroup B; Vaccine