title: Cost-effectiveness Comparison of Monovalent C Versus Quadrivalent ACWY Meningococcal Conjugate Vaccination in Canada.
abstract: In Quebec, 1 dose of monovalent C meningococcal conjugate vaccine (Men-C-Con) is offered at 12 months of age and a booster dose in grade 9 (14-15 years of age). In other Canadian provinces, a quadrivalent vaccine against serogroups ACWY (Men-4-Con) is increasingly used for adolescents. An economic analysis was performed to assess the value of a switch from Men-C-Con to Men-4-Con.
  
  
  
  A compartmental static simulation model was developed to assess the burden of invasive meningococcal disease due to serogroups AWY (AWY-IMD) in a cohort of 100,000 persons with different vaccination programs. Univariate and multivariate sensitivity analyses were performed, including variation in vaccine price difference ($12; range: $0-$20), AWY-IMD rate (0.08/100,000 to 0.28/100,000 person-years), level of herd immunity generated by adolescent vaccination (from zero to disease elimination) and discounting rate (0%, 3% or 6%).
  
  
  
  In the low AWY-IMD rate base scenario, replacing Men-C-Con by Men-4-Con for adolescents would reduce disease burden by 16% (no herd effect) to 58% (moderate herd effect), with an incremental cost-effectiveness ratios between $445,000 per quality-adjusted life-year (QALY) and $167,000/QALY in a societal perspective. In the high AWY-IMD rate scenario, incremental cost-effectiveness ratio would be in the range of $97,000/QALY to $19,000/QALY.
  
  
  
  Based on the epidemiologic conditions in Quebec and in most other Canadian provinces, the benefits of Men-4-Con in reducing the burden of disease would be low for a high cost. The switch would, however, be more economically attractive with a much higher incidence rate (as in a few provinces) or with a reduced vaccine price in conditions assuming a moderate to high herd effect.
authors.affiliation: From the *Centre de recherche du Centre hospitalier universitaire Québec, †Département de médicine sociale et préventive, Université Laval, and ‡Institut national de Santé publique du Québec, Quebec City, Québec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: De Wals
authors.forename: Zhou
authors.initials: Z
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D006801:Humans; D008589:Meningococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000008:administration & dosage / Q000191:economics*; D015999:Multivariate Analysis; D014611:Vaccination / Q000191:economics* / Q000706:statistics & numerical data*; D018074:Vaccines, Conjugate / Q000008:administration & dosage / Q000191:economics*
chemical_list: D022401:Meningococcal Vaccines; D018074:Vaccines, Conjugate