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. 2022 Feb;11(1):367-387.
doi: 10.1007/s40121-021-00573-w. Epub 2021 Dec 7.

Public Health Impact and Cost-Effectiveness Analysis of Routine Infant 4CMenB Vaccination in Germany to Prevent Serogroup B Invasive Meningococcal Disease

Stefan Scholz #  1 , Magdalena Schwarz #  2 , Ekkehard Beck  3 , Kinga Meszaros  3 , Melanie Schneider  4 , Bernhard Ultsch  4 , Wolfgang Greiner  1
Affiliations

Public Health Impact and Cost-Effectiveness Analysis of Routine Infant 4CMenB Vaccination in Germany to Prevent Serogroup B Invasive Meningococcal Disease

Stefan Scholz et al. Infect Dis Ther. 2022 Feb.

Erratum in

Abstract

Introduction: Invasive meningococcal disease (IMD) is an uncommon, severe, life-threatening disease primarily affecting infants, with potential lifelong sequelae. Neisseria meningitidis (Nm) serogroup B (MenB) causes most IMD cases in Germany, many of which can be prevented with four-component MenB (4CMenB) vaccination. The potential public health and economic impact of introducing routine 4CMenB infant vaccination in Germany was assessed.

Methods: A dynamic transmission-based cost-effectiveness model adapted for Germany assessed the impact of infant 4CMenB universal mass vaccination (UMV) versus no vaccination. The model included the latest real-world evidence on vaccine effectiveness, the comprehensive burden of disease on patients (sequelae) and their family (quality of life impact), comprehensive German IMD costs, and vaccination uptake assumptions.

Results: The largest public health impact was predicted in children: a rapid decline, 5 years after UMV implementation, of 39.9% (34.7%) for MenB (all IMD) cases aged 0-4 years and 42.4% (36.8%) in infants. Over lifetime (100-year time horizon), 4CMenB could prevent 3154 MenB (3303 all IMD) cases, 291 MenB (304 all IMD) deaths and 1370 MenB (1435 all IMD) long-term sequelae. 4CMenB saved 25,878 quality-adjusted life-years (QALYs), at a cost of €188,762 per QALY gained in the base case (societal perspective including lost productivity). Scenarios including potential Nm carriage protection (enabling herd protection) or societal preferences for the prevention of severe diseases led to more cost-effective results, while a scenario excluding IMD impact beyond the patient with increased discounting of vaccination health benefits produced less cost-effective results.

Conclusions: MenB IMD is a vaccine-preventable disease. This analysis for Germany can inform decision-makers on the potential impact of introducing infant 4CMenB UMV. The program is predicted to rapidly produce health benefits (reduction in child cases, deaths and sequelae) at a cost per QALY to society of around €190,000 (base case), decreasing to around €78,000 when considering societal preferences and IMD underreporting.

Keywords: 4CMenB; Cost-effectiveness; Germany; Infant; Meningococcal disease; Vaccination.

Plain language summary

Invasive meningococcal disease (IMD) is an uncommon but severe infection, usually presenting as meningitis and/or sepsis, caused by the bacteria Neisseria meningitidis. Most cases occur in infants, young children and adolescents. Patients who survive the disease can develop lifelong sequelae, such as physical, neurological and psychological/behavioural problems that impact their quality of life and that of their family/caregivers. This disease can be prevented by vaccination. The use of the four-component meningococcal serogroup B vaccine (4CMenB) in countries like Germany can prevent the most common form of this disease, IMD caused by serogroup B. This study assessed the public health and economic impact of infant vaccination in Germany with 4CMenB. For this, the authors used an economic model that measured the lifetime impact of the disease on patients but also on their families. The model predicted that after 5 years of vaccination, the number of cases and deaths in infants and young children aged 0–4 years would rapidly decrease by almost 40%. Over a long-term horizon of 100 years, this number was predicted to remain stable. Due to the reduced number of cases, vaccination would also result in fewer deaths and patients with sequelae, as well as cost savings for the healthcare system and society due to the reduced loss of productivity. In conclusion, in Germany, IMD caused by serogroup B is preventable through vaccination, and the 4CMenB vaccine in German infants is predicted to rapidly reduce the disease burden, save lives and prevent healthcare costs.

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Figures

Fig. 1
Fig. 1
Base case percentage reduction in invasive meningococcal disease (IMD) incidence due to meningococcal serogroup B (MenB) and all serogroups, relative to no vaccination (age group 0–4 years). UMV universal mass vaccination
Fig. 2
Fig. 2
Impact of single parameters considered in scenario analyses on the 4CMenB cost-effectiveness using a stepwise approach. Note: base case and scenarios to the right of the base case use discount rates of 3% for costs and 1% for HO. 4CMenB four-component meningococcal serogroup B vaccine; GDP gross domestic product; HO health outcomes; ICER incremental cost-effectiveness ratio; QAF quality of life adjustment factor; QALY quality-adjusted life year; SOP standard operating procedure; STIKO Standing Committee on Vaccination (Ständige Impfkommission)
Fig. 3
Fig. 3
Tornado diagram showing the 10 DSA results with the largest impact on the incremental cost-effectiveness ratio (ICER). 4CMenB four-component meningococcal serogroup B vaccine; DSA deterministic sensitivity analysis; MenB meningococcal serogroup B; QALY quality-adjusted life year
Fig. 4
Fig. 4
Cost-effectiveness acceptability curve (CEAC) for hypothetical cost-effectiveness thresholds of €37,046 (1 × GDP), €74, 092 (2 × GDP) and €111,138 (3 × GDP) per QALY gained. 4CMenB four-component meningococcal serogroup B vaccine; GDP gross domestic product; ICER incremental cost-effectiveness ratio; QALY quality-adjusted life year; UMV universal mass vaccination
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