Background
One dose of serogroup C meningococcal conjugate vaccine (MCV-C) at 12 months of age is the most common immunization schedule in Canada, but immunity may wane over time.Objectives
To assess the cost-effectiveness of a booster dose at 12 years of age with either MCV-C or a quadrivalent ACYW135 meningococcal conjugate vaccine (MCV-4).Methods
A simulation model for assessing both the direct and indirect effects of vaccination was developed. Age- and serogroup-specific incidence and fatality rates were derived from Canadian surveillance data. Vaccine efficacy was estimated from data from the U.K. and Spain, assuming an age-dependent decline of vaccine efficacy over time. Expected vaccine coverage rates were 90\% at 12 months, and 70\% at 12 years. Herd immunity was modeled using UK data. Vaccine purchase price per dose was \$23 for MCV-C and \$70 for MCV-4. Costs and health outcomes were discounted at 3\% per year. Results, expressed in 2004 Canadian \$ and from a societal perspective, were presented for a steady state situation and a population of 1 million.Results
Under the "no vaccination" base scenario, 5.7 cases of vaccine-preventable meningococcal disease would occur each year. Vaccination at 12 months using MCV-C would reduce the burden of disease by 32\%. Adding MCV-C at 12 years of age would reduce the number of cases by 55\% at no marginal cost, while using MCV-4 would result in a disease reduction of 78\% for a marginal cost of \$31 000 per QALY gained. Comparing MCV-4 with MCV-C as a booster dose, the incremental cost-effectiveness ratio would be \$113 000 per QALY. The efficacy of C-MCV vaccination at 12 months and the differential price between the two vaccines were the parameters having the strongest impact on the cost/QALY ratios. Any increase in the incidence of serogroup Y will improve the marginal cost-effectiveness ratio associated with MCV-4.Conclusion
Adolescent revaccination would be beneficial. Using C-MCV would be the most cost-effective option, while using MCV-4 would be more effective but would also require more investment.
%0 Journal Article
%1 de_wals_vaccinating_2007
%A Wals, Philippe De
%A Coudeville, Laurent
%A Trottier, Pierre
%A Chevat, Catherine
%A Erickson, Lonny J.
%A Nguyen, Van Hung
%D 2007
%J Vaccine
%K Conjugate Cost-effectiveness, Economics, Meningococcus vaccine,
%N 29
%P 5433--5440
%R 10.1016/j.vaccine.2007.04.071
%T Vaccinating adolescents against meningococcal disease in Canada: A cost-effectiveness analysis
%U http://www.sciencedirect.com/science/article/B6TD4-4NRCW4N-4/2/dc7ccaf84751cf95eb841216489a972d
%V 25
%X Background
One dose of serogroup C meningococcal conjugate vaccine (MCV-C) at 12 months of age is the most common immunization schedule in Canada, but immunity may wane over time.Objectives
To assess the cost-effectiveness of a booster dose at 12 years of age with either MCV-C or a quadrivalent ACYW135 meningococcal conjugate vaccine (MCV-4).Methods
A simulation model for assessing both the direct and indirect effects of vaccination was developed. Age- and serogroup-specific incidence and fatality rates were derived from Canadian surveillance data. Vaccine efficacy was estimated from data from the U.K. and Spain, assuming an age-dependent decline of vaccine efficacy over time. Expected vaccine coverage rates were 90\% at 12 months, and 70\% at 12 years. Herd immunity was modeled using UK data. Vaccine purchase price per dose was \$23 for MCV-C and \$70 for MCV-4. Costs and health outcomes were discounted at 3\% per year. Results, expressed in 2004 Canadian \$ and from a societal perspective, were presented for a steady state situation and a population of 1 million.Results
Under the "no vaccination" base scenario, 5.7 cases of vaccine-preventable meningococcal disease would occur each year. Vaccination at 12 months using MCV-C would reduce the burden of disease by 32\%. Adding MCV-C at 12 years of age would reduce the number of cases by 55\% at no marginal cost, while using MCV-4 would result in a disease reduction of 78\% for a marginal cost of \$31 000 per QALY gained. Comparing MCV-4 with MCV-C as a booster dose, the incremental cost-effectiveness ratio would be \$113 000 per QALY. The efficacy of C-MCV vaccination at 12 months and the differential price between the two vaccines were the parameters having the strongest impact on the cost/QALY ratios. Any increase in the incidence of serogroup Y will improve the marginal cost-effectiveness ratio associated with MCV-4.Conclusion
Adolescent revaccination would be beneficial. Using C-MCV would be the most cost-effective option, while using MCV-4 would be more effective but would also require more investment.
@article{de_wals_vaccinating_2007,
abstract = {Background
One dose of serogroup C meningococcal conjugate vaccine {(MCV-C)} at 12 months of age is the most common immunization schedule in Canada, but immunity may wane over {time.Objectives}
To assess the cost-effectiveness of a booster dose at 12 years of age with either {MCV-C} or a quadrivalent {ACYW135} meningococcal conjugate vaccine {(MCV-4).Methods}
A simulation model for assessing both the direct and indirect effects of vaccination was developed. Age- and serogroup-specific incidence and fatality rates were derived from Canadian surveillance data. Vaccine efficacy was estimated from data from the {U.K.} and Spain, assuming an age-dependent decline of vaccine efficacy over time. Expected vaccine coverage rates were 90\% at 12 months, and 70\% at 12 years. Herd immunity was modeled using {UK} data. Vaccine purchase price per dose was \$23 for {MCV-C} and \$70 for {MCV-4.} Costs and health outcomes were discounted at 3\% per year. Results, expressed in 2004 Canadian \$ and from a societal perspective, were presented for a steady state situation and a population of 1 {million.Results}
Under the "no vaccination" base scenario, 5.7 cases of vaccine-preventable meningococcal disease would occur each year. Vaccination at 12 months using {MCV-C} would reduce the burden of disease by 32\%. Adding {MCV-C} at 12 years of age would reduce the number of cases by 55\% at no marginal cost, while using {MCV-4} would result in a disease reduction of 78\% for a marginal cost of \$31 000 per {QALY} gained. Comparing {MCV-4} with {MCV-C} as a booster dose, the incremental cost-effectiveness ratio would be \$113 000 per {QALY.} The efficacy of {C-MCV} vaccination at 12 months and the differential price between the two vaccines were the parameters having the strongest impact on the {cost/QALY} ratios. Any increase in the incidence of serogroup Y will improve the marginal cost-effectiveness ratio associated with {MCV-4.Conclusion}
Adolescent revaccination would be beneficial. Using {C-MCV} would be the most cost-effective option, while using {MCV-4} would be more effective but would also require more investment.},
added-at = {2011-03-11T10:05:34.000+0100},
author = {Wals, Philippe De and Coudeville, Laurent and Trottier, Pierre and Chevat, Catherine and Erickson, Lonny J. and Nguyen, Van Hung},
biburl = {https://www.bibsonomy.org/bibtex/2f219a09bdbd1f2b4521477b5bb63a0fd/jelias},
doi = {10.1016/j.vaccine.2007.04.071},
interhash = {39d465875d79cace2a37c2a54f558896},
intrahash = {f219a09bdbd1f2b4521477b5bb63a0fd},
issn = {{0264-410X}},
journal = {Vaccine},
keywords = {Conjugate Cost-effectiveness, Economics, Meningococcus vaccine,},
month = jul,
number = 29,
pages = {5433--5440},
shorttitle = {Vaccinating adolescents against meningococcal disease in Canada},
timestamp = {2011-03-11T10:06:44.000+0100},
title = {Vaccinating adolescents against meningococcal disease in Canada: A cost-effectiveness analysis},
url = {http://www.sciencedirect.com/science/article/B6TD4-4NRCW4N-4/2/dc7ccaf84751cf95eb841216489a972d},
volume = 25,
year = 2007
}