Epidemiological impact and cost-effectiveness of introducing vaccination against serogroup B meningococcal disease in France

Introduction: Despite its low incidence in France, invasive serogroup B meningococcal disease remains a public health concern. A new vaccine against the disease, Bexsero (R), has been licensed in the EU. We studied the epidemiological impact and cost-effectiveness of routine vaccination using Bexsero (R) 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 ((sic)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 ((sic)135,902) preventing 24% of cases. Infant vaccination with a late booster and catch-up would prevent 51% of cases with a cost of (sic)188,511 per QALY gained. Conclusions: Given current meningococcal epidemiology in France and the available data on the protection provided by Bexsero (R), our modelling work showed that routine vaccination against serogroup B meningococcal disease is not cost-effective. (C) 2016 Elsevier Ltd. All rights reserved.