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Tuesday, March 22, 2005
257

Economics of an Adolescent Meningococcal Conjugate Vaccination Catch-up Campaign in the US

Ismael R. Ortega-Sanchez1, Martin I. Meltzer2, Colin W. Shepard2, Elizabeth R. Zell2, Mark L. Messonnier1, Oleg Bilukha2, Xinzhi Zhang2, David S. Stephens3, and Nancy Rosenstein2. (1) National Immunization Program/ ESD/ OD, Centers for Disease Control and Prevention, 1600 Clifton Road NE, M/S E-61, Atlanta, GA, USA, (2) National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, USA, (3) National Center for Infectious Diseases, Centers for Disease Control and Prevention & Emory University, 1600 Clifton Road NE, M/S C-09, Atlanta, GA, USA


BACKGROUND:
The US Food and Drug Administration is considering approval of a quadrivalent meningococcal conjugate vaccine (MCV-4). A one-time catch-up vaccination campaign in 11-17 year-olds, followed by routine annual immunization of each 11 year old cohort could take full advantage of vaccine benefits, but cost and feasibility issues are unresolved.

OBJECTIVE:
To analyze the effectiveness and cost-effectiveness of a catch-up campaign with MCV-4 in 11-17 year-olds.

METHOD:
We built a probabilistic model of disease burden and economic impacts for a 10 year period with and without an adolescent catch-up program. US age- and serogroup-specific surveillance data on incidence and case fatality rates were used, as were hypothetical age-specific reductions in attack rates in the unvaccinated. After projecting medical, indirect and program costs, we estimated costs per case averted, death prevented and life-year saved (LYS). Sensitivity analyses were conducted.

RESULT:
With herd immunity effects equivalent to recent experience in the United Kingdom, catch-up vaccination of healthy adolescents added to a routine program would prevent 5,263 cases in a 10-year period -- a 32% reduction. Excluding program costs, the catch-up would save $338 million in medical and public response costs and $591 million in time off work, long term disability and premature death. At a cost of $83 per vaccinee, catch-up would cost society $532,000 per case averted, $5.9 million per death prevented, and $138,000 per LYS. A 20% reduction in herd immunity effects would increase the cost per LYS by $21,000; a $30 decrease in the average cost of vaccination would decrease the cost per LYS by $55,000. Targeting highly endemic counties decreased the cost per LYS by two-thirds.

CONCLUSION:
Catch-up vaccination of adolescents can have a substantial impact on disease burden and costs. Compared with routine vaccination of each 11 year old cohort, catch-up vaccination could cost twice as much per LYS.

LEARNING OBJECTIVES:
Meningococcal conjugate vaccine, Adolescent, Cost-effectiveness, Catch-up, Herd immunity

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