Epidemiological impact and cost-effectiveness of universal vaccination with Bexsero(®) to reduce meningococcal group B disease in Germany.
Bexsero, a new vaccine against serogroup B meningococcal disease (MenB), was licensed in Europe in January 2013. In Germany, Bexsero is recommended for persons at increased risk of invasive meningococcal disease, but not for universal childhood vaccination. To support decision making we adapted the independently developed model for England to the German setting to predict the potential health impact and cost-effectiveness of universal vaccination with Bexsero(®) against MenB disease. We used both cohort and transmission dynamic mathematical models, the latter allowing for herd effects, to consider the impact of vaccination on individuals aged 0-99 years. Vaccination strategies included infant and adolescent vaccination, alone or in combination, and with one-off catch-up programmes. German specific data were used where possible from routine surveillance data and the literature. We assessed the impact of vaccination through cases averted and quality adjusted life years (QALY) gained and calculated costs per QALY gained. Assuming 65% vaccine uptake and 82% strain coverage, infant vaccination was estimated to prevent 15% (34) of MenB cases over the lifetime of one birth cohort. Including herd effects from vaccination increased the cases averted by infant vaccination to 22%, with an estimated 8461 infants requiring vaccination to prevent one case. In the short term the greatest health benefit is achieved through routine infant vaccination with large-scale catch-up, which could reduce cases by 24.9% after 5 years and 27.9% after 10 years. In the long term (20+ years) policies including routine adolescent vaccination are most favourable if herd effects are assumed. Under base case assumptions with a vaccine list price of €96.96 the incremental cost-effectiveness ratio (ICER) was >€500,000 per QALY for all considered strategies. Given the current very low incidence of MenB disease in Germany, universal vaccination with Bexsero(®) would prevent only a small absolute number of cases, at a high overall cost.
School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, England, United Kingdom. Electronic address: Hannah.christensen@bristol.ac.uk.
Hannah
H
Christensen
School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom. Electronic address: tom.j.irving@gmail.com.
Tom
T
Irving
Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany. Electronic address: KochJ@rki.de.
Judith
J
Koch
Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, United Kingdom. Electronic address: clt56@cam.ac.uk.
Caroline L
CL
Trotter
Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany. Electronic address: UltschB@rki.de.
Bernhard
B
Ultsch
Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany. Electronic address: WeidemannF@rki.de.
Felix
F
Weidemann
Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany. Electronic address: WichmannO@rki.de.
Ole
O
Wichmann
Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany. Electronic address: HellenbrandW@rki.de.
Wiebke
W
Hellenbrand
D003362:Cost-Benefit Analysis; D005858:Germany; D006801:Humans; D032521:Immunity, Herd; D007115:Immunization Schedule; D008589:Meningococcal Infections / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000191:economics* / Q000627:therapeutic use; D008962:Models, Theoretical; D038541:Neisseria meningitidis, Serogroup B; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics*
C570015:4CMenB vaccine; D022401:Meningococcal Vaccines
Cost-effectiveness; Meningococcal disease; Model; Serogroup B