Revisiting the Cost-Effectiveness of Adolescents Meningococcal Vaccination In the United States

Background:  In 2005, a quadrivalent (seroroups A, C, Y, and W-135) meningococcal conjugate vaccine (MCV4) was licensed and recommended for vaccinating adolescents aged 11 years.  In 2008 the recommendation was extended to all adolescents aged 11-18 years. Initial meningococcal cost-effectiveness assumed that vaccination provided full protection for 10 years.  However, preliminary immunogenicity studies report that circulating antibodies considerably low 5 years after vaccination. Reducing the duration of protection will have a substantial impact on the cost-effectiveness of the current meningococcal conjugate vaccines for adolescent.

Objectives: To compare the cost-effectiveness of three routine adolescent vaccination policies with MCV4 in the US assuming a 5-year vaccine efficacy duration.

Methods:  Using a probabilistic cohort model we estimated the meningococcal disease burden and economic impacts for a 10-year period with and without an adolescent meningococcal vaccination program.  Three vaccination strategies were analyzed: one dose at 15 years, two doses at 11 and 16 years, and one dose at 11 years. We used recent US age- and serogroup-specific surveillance data on incidence and mortality and a 5-year vaccine efficacy duration.  We estimated costs per case, death prevented, life-years saved (LYS) and quality adjusted life-years saved (QALY). 

Results: The three vaccination strategies with a meningococcal conjugate vaccine would still reduce the meningococcal disease burden in adolescents but at higher societal costs. Among the three strategies, the current one-dose-at-11-years vaccination strategy would the less cost-effective ($281000 per QALY) and the one-dose-at-15-years the most cost-effective ($121000 per QALY).  Vaccinating adolescent with two doses at 11 and 16 years of age cost $157000 per QALY.

Conclusions: A 5-year vaccine efficacy duration makes vaccinating at 11 years the less cost-effective strategy.  Although vaccinating at 15 years would prevent the greatest number of cases per dose, vaccinating at 11 and 16 years of age would prevent the most number of cases.