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Combination Vaccine Against Invasive Meningococcal B and Pneumococcal Infections

Potential Epidemiological and Economic Impact in The Netherlands

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Abstract

Background

Streptococcus pneumoniae and Neisseria meningitidis group B are among the main causes of invasive bacterial meningitis infections in infants. Worldwide, these diseases lead to significant mortality, morbidity and costs. The societal impact is especially severe since the majority of cases occur in very young infants. A combination vaccine consisting of 9-valent conjugated pneumococcal and meningococcal B components is currently being developed. The aim of this study was to estimate the potential impact and cost effectiveness from the societal perspective of vaccinating infants in The Netherlands with this combination pneumococcal and meningococcal B vaccine versus no vaccination.

Methods

A Markov cycle model was developed using epidemiological and healthcare resource use data from 1996 to 2001. This model was used to project the annual costs, benefits and health gains associated with vaccinating all newborns. The base year for the costing was 2003 and all costs and health effects were discounted at 4%. The results of the analysis are expressed in costs per QALY and both probabilistic and univariate sensitivity analyses were used to identify the robustness of the results.

Results

Annually, an average of 755 cases of invasive pneumococcal and meningococcal B infection occurred in infants aged 0–10 years in The Netherlands. Introduction of the combination vaccine would prevent 201 cases of meningococcal B meningitis and 165 cases of invasive pneumococcal disease per year. Additionally, 3410 cases of pneumococcal pneumonia and 46 350 cases of otitis media would be prevented. Vaccination would save 35 lives per year and prevent 71 cases of severe sequelae. This translates into 860 life-years gained, or 1128 QALYs gained.

Alongside these health gains, vaccination would prevent €17 681 370 of direct medical and indirect costs attributable to meningococcal and pneumococcal infections in The Netherlands. Depending on vaccine price, cost effectiveness varied from €3160 (vaccine price per dose €20) to €32 170 (vaccine price €60 per dose) per QALY. Base-case cost effectiveness (vaccine price €40) was €17 700 per QALY. The model was most sensitive to changes in incidence, vaccine price and duration of protective efficacy.

Conclusion

Our results suggest that the introduction of a combination meningococcal B and pneumococcal vaccine into the Dutch infant vaccination programme is potentially cost effective compared with no vaccination.

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Notes

  1. The expert panel consisted of members of the infectious diseases section of the Dutch Paediatric Society, which consists of representatives of most of the paediatric departments of university hospitals in The Netherlands. The expert panel was consulted on both the resource use of meningococcal and pneumococcal infections as well as assumptions on the severity of disease. Opinions of all specialists were noted and mean values were obtained for resource use (apart from number of inpatient days, which were derived from Prismant Healthcare).[24] For further details regarding the procedure, see Bos et al.[25]

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Acknowledgements

This study was performed by Jasper Bos while employed by the Netherlands Vaccine Institute. No relevant conflicts of interest exist. This study was funded by the Netherlands Vaccine Institute, Bilthoven, The Netherlands. The Netherlands Vaccine Institute is a governmental institution that, amongst others, advises on the National Vaccination Programme.

Jasper Bos was primary investigator and conducted the major share of study design, data analysis and reporting.

Hans Rümke and Loek van Alphen co-authored on the paper, provided the vaccine-specific expertise and assisted in data collection.

Robert Welte co-authored and assisted in the design of the analysis.

Lodewijk Spanjaard co-authored and assisted in data collection and verification.

Maarten Postma and Loek van Alphen supervised all stages of the project.

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Authors and Affiliations

  1. Department of Social Pharmacy, Pharmaco-Epidemiology and Pharmacotherapy, Groningen University Institute for Drug Exploration/University of Groningen Research Institute of Pharmacy (GUIDE/GRIP), Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands

    Jasper M. Bos & Maarten J. Postma

  2. The Netherlands Vaccine Institute, Bilthoven, The Netherlands

    Jasper M. Bos & Loek van Alphen

  3. Vaccine Centre, Erasmus University, Rotterdam, The Netherlands

    Hans C. Rümke

  4. GSF - National Research Centre for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany

    Robert Welte

  5. Department of Medical Microbiology, Academic Medical Centre, The Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam, The Netherlands

    Lodewijk Spanjaard

Authors
  1. Jasper M. Bos
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  2. Hans C. Rümke
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  3. Robert Welte
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  4. Lodewijk Spanjaard
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  5. Loek van Alphen
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  6. Maarten J. Postma
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Correspondence to Jasper M. Bos.

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Bos, J.M., Rümke, H.C., Welte, R. et al. Combination Vaccine Against Invasive Meningococcal B and Pneumococcal Infections. Pharmacoeconomics 24, 141–153 (2006). https://doi.org/10.2165/00019053-200624020-00004

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