The objective of this study is to assess the cost-effectiveness of a MenB childhood vaccination program from the Ontario healthcare payer perspective.
Method: A Markov cohort model of invasive MenB disease was developed based on Ontario-specific MenB incidence, mortality and cost data, as well as data from the literature on MenB vaccine immunogenicity, adverse events, incidence of sequelae and health-related quality of life. Based on the current literature, a 4-dose vaccination schedule, 98% coverage, 66% effectiveness, 10-year duration of protection and C$90 per dose were assumed. A hypothetical Ontario birth cohort (n=150,000) was simulated to estimate expected lifetime health outcomes such as MenB disease cases, sequelae, mortality, quality-adjusted life years (QALYs) and costs (e.g., vaccination program, contact management, treatment of MenB disease). Primary outcomes were expected QALYs, cost, and incremental costs per QALY gained. Extensive sensitivity analyses were conducted. QALYs and costs were discounted at 5%.
Result: A MenB infant vaccination program is expected to prevent 4 invasive MenB disease cases and 0.4 related death over the lifetime of an Ontario birth cohort, equivalent to 11.68 discounted QALYs gained. The vaccination program costs are estimated to be C$56,567,805 (including C$1,001,805 for treatment of vaccine-related adverse events) per cohort. Vaccination program cost were not offset by healthcare cost savings (C$385,578) due to preventing the 4 cases (treatment of cases and contact management), resulting in an incremental cost effectiveness ratio of C$4.8 million per QALY gained. The model was most sensitive to vaccine effectiveness, vaccine price, incidence of MenB disease and discount rate. However, uni- and multivariate sensitivity analyses across plausible ranges, including approximating herd immunity effects, did not result in the vaccination program being cost-effective.
Conclusion: This analysis suggests that a MenB vaccination program significantly exceeds commonly used cost-effectiveness thresholds and thus is unlikely to be considered economically attractive. These findings provide timely economic evidence for public health policy-decision makers in Ontario and other jurisdictions considering a publicly funded MenB vaccination program.