OBJECTIVES: Invasive meningococcal disease (IMD) is an uncommon but severe disease that can cause life-long sequelae or death. The main burden of IMD in Germany is caused by Neisseria meningitidis serogroup B (MenB). The multicomponent MenB (4CMenB) vaccine is licensed from two months of age to provide protection against MenB-IMD. The objective of this study was to evaluate the public health and health economic impact of 4CMenB routine infant-vaccination in Germany.

METHODS: We adapted a dynamic transmission-based cost-effectiveness model to the German setting by using data on demographics, epidemiology, vaccine uptake, disease-burden of patients and surrounding family-network, and costs from societal perspective. The model considers single age-groups 0-99+ years over a 100-year time horizon. Besides a base-case analysis, we conducted scenario, deterministic and probabilistic sensitivity-analyses (DSA, PSA) to assess the robustness of findings.

RESULTS: A 4CMenB routine infant-vaccination was predicted to reduce MenB-IMD incidence by 41% in children 0-4 years of age within five years after introduction. Over 100 years, more than 3.2k MenB-IMD cases and 299 deaths could be averted. The base-case resulted in €177k/quality-adjusted life-year (QALY) with average annual undiscounted vaccination costs of €125m, i.e. ~10% of expenses for vaccination. Considering different scenarios, (i) a conservative approach using the cost-effectiveness analysis framework of the German Standing Committee on Vaccination, (ii) potential underreporting and (iii) a high incidence season, the model calculated (i) €738k/QALY, (ii) €146k/QALY and (iii) €53k/QALY, respectively. DSA showed that the discount rate for health outcomes had the highest impact on results, while PSA demonstrated that the base-case reflected a robust estimate of the parameter uncertainty.

CONCLUSIONS: Different scenarios were considered to take the uncommonness and severity of MenB-IMD into account. Our results show that MenB-IMD can be widely prevented through 4CMenB routine infant-vaccination in Germany with an additional investment of ~10% of the annual immunization-expenses.