Modelling the epidemiological impact and cost-effectiveness of possible changes to the meningococcal vaccination schedule for adolescents and young adults in the United States

Abstract

Background: The U.S. adolescent meningococcal vaccination schedule includes a quadrivalent meningococcal conjugate vaccine (MenACWY) dose at 11–12 years, a booster at 16 years, and—through shared clinical decision-making—a meningococcal serogroup B vaccine (MenB) series at 16 years and 6 months later (Q-QB-B schedule). This study evaluates the public health impact and cost-effectiveness of possible revisions to the schedule, considering the options currently under review by the Advisory Committee on Immunization Practices (ACIP). Methods: We used a static, incidence-based population model to compare invasive meningococcal disease (IMD) incidence and mortality, quality-adjusted life years (QALYs), and costs. The model focused on serogroup B, C, W, and Y disease in a cohort of 11–25-year-olds. Incremental outcomes were estimated per year of incidence from the societal perspective for different schedules compared to Q-QB-B, applying a lifetime horizon to long-term IMD consequences. Results: With Q-QB-B, 50 IMD cases were estimated to occur annually, resulting in 296 QALYs lost and total costs of $1.6 million (M). The N-P-B schedule (which eliminates the MenACWY dose at 11–12 years, replaces MenACWY and MenB with the pentavalent vaccine [MenABCWY] at age 16 years, and maintains administration of a MenB dose 6 months later) was less effective than Q-QB-B, leading to 13.7 additional IMD cases annually. It was also less costly, resulting in $599 M in savings and an incremental cost-effectiveness ratio (ICER) of $6.0 M per QALY lost. Relative to Q-QB-B, the Q-P-B schedule was estimated to avoid 1.5 additional IMD cases annually; all due to serogroup B, consistent with higher vaccination coverage against this serogroup in the Q-P-B schedule in which the second MenACWY dose and the first MenB dose at age 16 are replaced by MenABCWY. The additional costs for Q-P-B relative to Q-QB-B were estimated at $36.8 M and the ICER at $4.5 M per QALY gained. Conclusions: Q-QB-B was the most cost-effective schedule. Scenarios replacing the MenACWY dose at age 16 years with MenABCWY were not cost-effective vs. Q-QB-B. While cost savings could result from eliminating the first MenACWY dose, this was estimated to result in increased IMD incidence with associated mortality and morbidity.