%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 }