OBJECTIVES:

Invasive meningococcal disease (IMD) is a severe and unpredictable disease, causing acute meningitis and sepsis, which are associated with high mortality and long-term consequences. A national immunization programme to prevent IMD caused by meningococcal serogroups A, C, W and Y has been introduced in the Netherlands. This study aimed to estimate the incremental cost-effectiveness ratio (ICER) of introducing the protein-subunit-meningococcal-B-vaccine (4CMenB) to prevent IMD caused by Meningococcal B by using a dynamic transmission-based cost-effectiveness (DyCE) model.

METHODS:

The DyCE model was used to simulate the future overall incidence of Meningococcal B, based on 2010-2019 incidence data. In the base case, 50 cohorts of young children were vaccinated and followed over lifetime (100 years). Compared to a previously published study in 2013, the current analysis included an improved estimation of the long-term IMD complications, new data regarding vaccine effectiveness and an optimized vaccination schedule. We estimated the ICER in different scenarios where the vaccine price and number of cohorts vaccinated were varied. Also, the incidence was varied to assess the impact of a potential outbreak in the future.

RESULTS:

The ICER for the base-case analysis was estimated to be €105,525 per Quality-Adjusted Life-Year (QALY) gained, with a vaccine price of €78.50, 50 cohorts being vaccinated and an average, relatively low, incidence from 2010 to 2019. When excluding mental health sequelae in the model, the ICER increased to €131,940. When varying the incidence to levels seen in 1990-1999 (x5) or 2000-2009 (x3), the ICER became more favourable and potentially cost-effective against a willingness-to-pay threshold of €80,000 per QALY gained. Combining this with a potentially reduced vaccine price would further promote favourable ICER values.

CONCLUSIONS:

Introducing 4CMenB could be cost-effective in the Netherlands when different scenarios of an increased incidence and/or a reduced vaccine price are assumed.