Document text
Economic Analyses of GSK MenABCWY Vaccinations
among Adolescents in the United States
Xiaoyu Donga, PhD, Andrew J Leidnera, PhD, Sarah F Schilliea, MD,
Lucy Alexandra McNamaraa, PhD
a National Center for Immunization & Respiratory Diseases, CDC
Disclaimers: The findings and conclusions in this report are those of the authors and do not necessarily represent the
views of the Centers for Disease Control and Prevention. National Center for Immunization & Respiratory Diseases
ACIP Meeting
October 24, 2024
•Authors have no known conflict of interestsConflict of Interest
2
•Q=MenACWY (Quadrivalent)
•B=MenB
•P=MenABCWY (Pentavalent)
•QALY=Quality -adjusted life year
•ICER= Incremental cost-effectiveness ratio ($/QALY)
•IMD=Invasive meningococcal disease
•VE=Vaccine effectiveness
•PICO= Population intervention comparator outcomeAcronyms
3
•Research Question
•Methods
•Model Inputs
•Results
•Sensitivity Analyses
•Comparison to GSK’s Model
•Limitations
•SummaryOutline
4
•What is the cost -effectiveness of vaccinating adolescents with the GSK
pentavalent vaccine ( MenABCWY ) compared to the current
recommendation of MenACWY / MenB vaccine?Research Question
5
•Current Recommendation
-MenACWY vaccine (Q): 1st dose at 11 –12 yrs; 2nd dose at 16 yrs.
-MenB vaccine (B): 1st and 2nd dose at 16 –23 yrs (preferred 16 –18 yrs),
based on shared clinical decision -making.
•Policy Question (PICO):
-PICO 1: Should the pentavalent vaccine (P , MenABCWY ) be included as an option
for MenACWY /MenB vaccination in people currently recommended to receive
both vaccines at the same visit? Q -P-B
-PICO 2: Should the pentavalent vaccine be included as an option for people
currently recommended to receive MenACWY only? P -P
-PICO 3: Should the pentavalent vaccine be included as an option for people
currently recommended to receive MenB only? Q-P-PaOverview
Q-QB-B
6a For PICO 3 in this model, the P -P doses are given at the same coverage rate currently experienced by B -B.
Methods
7
Economic Analysis
PICO Interventions Comparators
1 Q-P-B Q-QB-B
2 P-P Q-Q
3 Q-P-P Q-QB-B / Q -P-B
For reference Q-P-B / Q -QB-B / P -P /
Q-Q / Q-P-PNo vaccination
CostsIntervention – CostsComparator Change in costs
= = $/Outcome
OutcomesIntervention – OutcomesComparator Change in outcomes
8Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine.
Model Diagrama
9
a Notes: 1/ This figure illustrates any type of vaccine administration at specific ages, for example "Q dose 1 at 11 years old" or "B dose 2 at 17 years old."
2/ Over time, the portion of the population "protected by vaccine" will decrease as vaccine effectiveness wanes, shifting the se individuals to the "not
protected by vaccine" compartment. 3/ Age -based background mortality rates were applied to all individuals in the model but are not represented in
the diagram.
b Potential sequelae include hearing loss, skin scarring, neurological disabilities, and amputations. See slide 15 for more det ails.
•Population -based Model
-Single age cohort, cohort starts at 11 years old (initial population size: 4,068,564 )
•Analytic Horizon :
-Vaccination costs and meningococcal cases are assessed for 19 years (age 11
through 29)
-Costs and health outcomes of meningococcal cases are assessed from age 11
through the entire lifetime
•Discount Rate : 3%
•Currency Year: 2024$US
•Perspective : Societal
•Time Step : 0.5 year
-Outcomes are calculated every 6 months in the modelEconomic Model
10
•Inputs
-Population and Epidemiology
-Vaccine Characteristics
-Costs (2024$)
-Quality of Life Impacts of IMD (Invasive Meningococcal Disease) and Sequalae
•Outputs
-Health Outcomes: episodes of IMD, and deaths
-Costs Outcomes: direct medical costs, productivity costs, and vaccination costs
-Incremental Cost -effectiveness Ratio (ICER) : $/QALY savedInputs and Outputs
11IMD=Invasive meningococcal disease; QALY=Quality -adjusted life year.
Model Inputs
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•Population Size, and Background Mortality Rate By Agea
•IMD Incidence Rate by Ageb:
-Serogroups ACWYc:
•Unvaccinated individuals experience pre -vaccine era incidence (2003 -2005)
-Serogroup B:
•Unvaccinated individuals experience pre -vaccine era incidence (2012 -2014)
•Case Fatality Ratec,d
•Probability of Sequalae Given IMD EpisodeePopulation and Epidemiological Inputs
a CDC WONDER b Active Bacterial Core Surveillance and NNDSS data
c Surveillance data primarily captures serogroup CWY because there is minimal serogroup A disease in the US.
d Enhanced Meningococcal Disease Surveillance Report 2020 -23 e Ortega -Sanchez IR, ACIP presentation, June 202313IMD=Invasive meningococcal disease.
IMD Incidence Rates among Unvaccinated by Agea,bPopulation and Epidemiological Inputs
Case Fatality Ratesb,c
Serogroup Base Low High
ACWY 15.4% 9.2% 19.4%
B 9.4% 6.6% 10.9%
a Active Bacterial Core surveillance and NNDSS data; pre -vaccine era: 2003 -05 for serogroups ACWY, and 2012 -14 for serogroup B.
b Surveillance data primarily captures serogroup CWY because there is minimal serogroup A disease in the US.
c Enhanced Meningococcal Disease Surveillance Report 2020 -23 14
IMD=Invasive meningococcal disease.
•Percentage of IMD Cases Developing SequelaeaPopulation and Epidemiological Inputs
Type of Condition Base Low High
Hearing Loss 8.8% 2.0% 20.0%
Skin Scarring 7.6% 0.00% 19.0%
Neurologic Disability 2.1% 0.02% 11.0%
Single Amputation 1.9% 0.5% 10.0%
Multiple Amputation 1.2% 0.02% 6.0%
aOrtega -Sanchez IR, ACIP presentation, June 2023
15IMD=Invasive meningococcal disease.
•Initial Vaccine Effectiveness (VE) by Serogroupsa and Doses of VaccineVaccine Inputs
MenACWY (Q) MenB (B)
1st Dose79%
(49% -91%)c64%
(54% -85%)e
2nd + Doseb 99%
(95% -100%)d79%
(63% -85%)f
16a The VE for the first dose of MenACWY is based on observed clinical effectiveness, whereas all other VE values are derived from immunogenicity data.
b For the Q -P-P strategy, we assume that the last dose of P (i.e., the 3rd dose with serogroup ACWY protection) provides the same initial VE and rate of waning
for serogroup ACWY as the 2nd dose MenACWY .
c Cohn AC et al . Pediatrics. 2017
d Tipton M et al . Vaccine. 2019; Baxter R et al. Pediatr Infect Dis J. 2014 ; Germán Áñez G et al . Hum Vaccin Immunother . 2020 .
e Santolaya ME et al . Human Vaccines & Immunotherapeutics . 2013 ; Watson PS et al. Expert Review of Vaccines, 2019 ; Castilla et al. N Engl J Med, 2023
fWatson PS et al. Expert Review of Vaccines, 2019 ; Vesikari T et al . Hum Vaccin Immunother , 2021.
•Initial and Duration of Vaccine Effectiveness (VE) by Serogroups and DosesaVaccine Inputs
17▪MenACWY Vaccine (Q) ▪MenB Vaccine (B)
a Cohn AC et al . Pediatrics. 2017 ; Baxter R et al. Pediatr Infect Dis J. 2014 ; Mbaeyi SA et al . MMWR Recomm Rep. 2020 ; Santolaya ME et al . Human Vaccines &
Immunotherapeutics . 2013 ; Watson PS et al. Expert Review of Vaccines, 2019 ; Vesikari T et al . Hum Vaccin Immunother , 2021.
•Vaccination Coverage by Strategy and Vaccine Type (Q, B, P)Vaccine Inputs
Age at Vaccination
12y 16.5y 17y
Current Rec: Q -QB-BaQ (88.4%) Q (59.7%) B (32.4%) B (12.8%)
Intervention: Q -P-B Q (88.4%) Q (27.3%) P (32.4%) B (12.8%)
Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine .
a National Immunization Survey Data, 2023, https://www.cdc.gov/mmwr/volumes/73/wr/mm7333a1.htm#T1_ down .PICO 1
18
•Vaccination Coverage by Strategy and Vaccine Type (Q, B, P)Vaccine Inputs
Age at Vaccination
12y 16.5y 17y
Current Rec: Q -QB-BaQ (88.4%) Q (59.7%) B (32.4%) B (12.8%)
Q-P-B Q (88.4%) Q (27.3%) P (32.4%) B (12.8%)
Intervention: P -P P (88.4%) P (59.7%)
Q-Q Q (88.4%) Q (59.7%)PICO 2
19Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine .
a National Immunization Survey Data, 2023, https://www.cdc.gov/mmwr/volumes/73/wr/mm7333a1.htm#T1_ down .
•Vaccination Coverage by Strategy and Vaccine Type (Q, B, P)Vaccine Inputs
Age at Vaccination
12y 16.5y 17y
Current Rec: Q -QB-BaQ (88.4%) Q (59.7%) B (32.4%) B (12.8%)
Q-P-B Q (88.4%) Q (27.3%) P (32.4%) B (12.8%)
P-P P (88.4%) P (59.7%)
Q-Q Q (88.4%) Q (59.7%)
Intervention: Q -P-P Q (88.4%) Q (27.3%) P (32.4%) P (12.8%)PICO 3
20Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine .
a National Immunization Survey Data, 2023, https://www.cdc.gov/mmwr/volumes/73/wr/mm7333a1.htm#T1_ down .
•Vaccine Cost per Dose (2024$)Vaccine Inputs
Q (MenACWY ) B (MenB ) P (MenABCWY )Admin Costa
Menveo MenQuadfi Bexsero Trumenba GSK Vaccineb
Publicc$109 $111 $150 $136 $181 $34
Privatec$168 $184 $243 $206 $241 $34
Market Shared50% 50% 75% 25% 100%
Weighted Cost+
Admin$177 $224 $245
a Tsai Y et al. Preventive Medicine Reports. 2019
b GSK presentation to the CDC .
c 2024 public and private sector cost per dose by CDC; the private sector price has been further adjusted by the estimates from the MarketScan Claims Database;
the percentages of vaccines purchased, and vaccinations administered are assumed to be 50% private sector and 50% public sect or.
d Market share data are obtained from the MarketScan Claims Database and Vaccine for Children (VFC) data.
21
Cost Inputs
Direct CostaIndirect Costa
(Productivity Lossb) Base Low High
IMD $68,544 $31,255 $110,959
Hearing Loss $7,643 $7,039 $11,463 33% Productivitya-c
Skin Scarring $92,055 $26,918 $116,594
Neurologic Disability $2,989,564 $1,075,447 $3,631,592 100% Productivitya-c
Single Amputation $209,152 $104,575 $313,727 15% Productivityb-d
Multiple Amputation $250,984 $125,491 $376,474 30% Productivitya-c
Premature death, 11 -17 $1,750,511
Premature death, 18 -29 $1,832,198
IMD=Invasive meningococcal disease.
aOrtega -Sanchez IR, ACIP presentation, June 2023 ; All costs have been converted to 2024 $.
b Grosse SD et al . J Med Econ. 2019
c The productivity loss from an occurrence of permanent sequelae depends on the age at which the sequelae occurred and the percentage productivity that is
impacted by the sequalae.
d Assumes that a single amputation episode experiences half the productivity loss of a multiple amputation episode. 22
QALY Inputs: Relative Quality of Life (0 -1 scale) with and
without IMD and Sequelae
Base Low High Duration
Background Utilitya-c0.92 0.89 0.94
IMD without Sequalaeb
0.91 0.88 0.946 months
Hearing Lossb0.72 0.64 0.82 Lifetimea,c
Skin Scarringb0.95 0.80 1.00 Lifetimea,c
Neurologic Disabilityb0.06 0.00 0.39Lifetimea,c
Single Amputationb0.70 0.31 0.80 Lifetimea,c
Multiple Amputationb0.61 0.31 0.71Lifetimea,c
Death 0 0 0
QALY=Quality -adjusted life year; IMD=Invasive meningococcal disease.
a QALY impacts for sequalae are included in the model as multiplicative weights that are combined with the background utility, so the QALY
value for skin scarring during the years after the IMD episode is equal to 0.874 = 0.95 * 0.92.
b Ortega -Sanchez IR, ACIP presentation, June 2023
c Jiang R et al. Qual Life Res. 2021
23
Results
24
Health Outcomesa: Cumulative Number of IMD Cases and
Deaths for a Single Birth Cohort from Ages 11 through 29 Years
a All numbers are cumulative over the analytical horizon of the model for a single cohort of 11 -year -olds. For example, in the “No Vaccination” strategy, there were a
total of 233 undiscounted episodes of IMD among about 4 million individuals, who started in the model at 11 years old and age d to 29 years old.25PICO 1
Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine; IMD=Invasive meningococcal disease.
.
a All numbers are cumulative over the analytical horizon of the model for a single cohort of 11 -year -olds. For example, in the “No Vaccination” strategy, there were a
total of 233 undiscounted episodes of IMD among about 4 million individuals, who started in the model at 11 years old and age d to 29 years old.26Health Outcomesa: Cumulative Number of IMD Cases and
Deaths for a Single Birth Cohort from Ages 11 through 29 Years
Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine; IMD=Invasive meningococcal disease.
.PICO 2: 12 IMD, 1 Death
a All numbers are cumulative over the analytical horizon of the model for a single cohort of 11 -year -olds. For example, in the “No Vaccination” strategy, there
were a total of 233 undiscounted episodes of IMD among about 4 million individuals, who started in the model at 11 years old and aged to 29 years old.27PICO 3: 1 IMDHealth Outcomesa: Cumulative Number of IMD Cases and
Deaths for a Single Birth Cohort from Ages 11 through 29 Years
Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine, IMD=invasive meningococcal disease.
.
Cost Outcomesa,b: Cumulative Costs for a Single Birth
Cohort from Ages 11 through 29 Years
Direct Medical Costs
+ Productivity Costs
($Millions)Vaccination Costs
($Millions)Total Costs
($Millions)
No Vaccination $93 0 $93
Current Rec: Q -QB-B $52 $1,331 $1,383
Q-P-B $52 $1,156 $1,208
P-P $50 $1,360 $1,410
Q-Q $54 $983 $1,036
Q-P-P $52 $1,165 $1,217
a Annual discount rate is 3 %.
b All costs have been converted to 2024$. 28Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine.
Cost -effectiveness of Intervention Strategy vs.
Comparator Strategy for 3 PICO Questions
Q-QB-B Q-P-B P-P Q-Q Q-P-P
No Vaccination $3,572,475 $3,090,247 $3,439,068 $2,697,932 $3,097,938PICO Intervention Comparator Diff. in QALYsaDiff. in CostaICER
($/QALY)
1 Q-P-B Q-QB-B 0 -$175 million Cost -savingb
2 P-P Q-Q 33 $373 million $11,332,778
3 Q-P-PQ-QB-B 2 -$166 million Cost -saving
Q-P-B 2 $9 million $4,510,830
a Annual discount is 3%; 2024$.
b In this comparison, costs are reduced, but health outcomes remain the same when comparing Q -P-B to Q -QB-B.•Cost per QALY Gained for Each Vaccination Strategy vs. No Vaccination
29Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine; QALY=Quality -adjusted life year.
Sensitivity Analyses
30
a This figure presents the six most impactful inputs. Other inputs that were assessed but not included above because they were less impactful: QALYs for each category (background,
IMD, and sequelae), costs for each category (IMD, sequelae, and death), case fatality ratios for serogroups ACWY and B, rate of skin scarring and multiple amputation from IMD, and
IMD incidence of serogroups ACWY. At the lower value of P vaccine cost, the ICER was cost -saving, meaning that P -P improves heal th with less costs relative to Q -Q.
b For the high assumption, we use pre -vaccine era data going back to 1996 to estimate incidence rates among the unvaccinated; for the lower assumption, we assume that the
incidence rates are 80% of the base case values.Sensitivity Analysis 1: P -P vs. Q -Qa
31
Q=Quadrivalent ( MenACWY ) vaccine; P=Pentavalent ( MenABCWY ) vaccine; IMD=Invasive meningococcal disease; QALY=Quality -adjusted life year.Base Case: $11.3 million/QALY
Cost -savinga
a This figure presents the six most impactful inputs. Other inputs that were assessed but not included above because they were less impactful: QALYs for each category (background,
IMD, and sequelae), costs for each category (IMD, sequelae, and death), case fatality ratios for serogroups ACWY and B, rate of skin scarring and multiple amputation from IMD, and
IMD incidence of serogroup B. At the lower value of P vaccine cost, the ICER was cost -saving, meaning that Q -P-P improves health with less costs relative to Q -P-B.
b For the high assumption, we use pre -vaccine era data going back to 1996 to estimate incidence rates among the unvaccinated; for the lower assumption, we assume that the
incidence rates are 80% of the base case values.Sensitivity Analysis 2: Q -P-P vs. Q -P-Ba
32
Q=Quadrivalent ( MenACWY ) vaccine; P=Pentavalent ( MenABCWY ) vaccine; IMD=Invasive meningococcal disease; QALY=Quality -adjusted life year.Cost -savingaBase Case: $4.5 million/QALY
•Incidence among unvaccinated uses pre-vaccine era data going back to 1996:
-Serogroups ACWYa: 1996 -2005 (compared to 2003 -05 in the base case)
-Serogroup B: 1996 -2013 (compared to 2012 -14 in the base case)
33Sensitivity Analysis 3: Higher IMD Incidence Rate for
both MenACWY and MenB
a Surveillance data primarily captures serogroup CWY because there is minimal serogroup A disease in the US.
Q=Quadrivalent ( MenACWY ) vaccine; P=Pentavalent ( MenABCWY ) vaccine; IMD=Invasive meningococcal disease; QALY=Quality -adjusted life year.
.Q-QB-B Q-P-B P-P Q-Q Q-P-P
No Vaccination $1,522,460 $1,309,296 $1,420,918 $1,140,061 $1,314,758PICO Intervention ComparatorICER ($/QALY)
Higher IncidenceICER ($/QALY)
Base Case
1 Q-P-B Q-QB-B Cost -savingaCost -savinga
2 P-P Q-Q $3,623,638 $11,332,778
3 Q-P-PQ-QB-B Cost -saving Cost -saving
Q-P-B $2,690,624 $4,510,830
a In this comparison, costs are reduced, but health outcomes remain the same when comparing Q -P-B to Q -QB-B.•Cost per QALY Gained for Each Vaccination Strategy vs. No Vaccination•Cost -effectiveness of Intervention Strategy vs. Comparator Strategy for
3 PICO QuestionsSensitivity Analysis 3: Higher IMD Incidence Rate for
both MenACWY and MenB
34
Q-QB-B Q-P-B P-P Q-Q Q-P-P
No Vaccination $3,359,810 $2,905,375 $3,020,948 $2,697,932 $2,913,568PICO Intervention ComparatorICER ($/QALY)
Higher IncidenceICER ($/QALY)
Base Case
1 Q-P-B Q-QB-B Cost -savingaCost -savinga
2 P-P Q-Q $4,369,184 $11,332,778
3 Q-P-PQ-QB-B Cost -saving Cost -saving
Q-P-B $4,510,830 $4,510,830
a In this comparison, costs are reduced, but health remains the same when comparing Q -P-B to Q -QB-B. 35Sensitivity Analysis 4: Higher IMD Incidence Rate for
MenB among 18 -24 Years Old
•Cost -effectiveness of Intervention Strategy vs. Comparator Strategy for
3 PICO Questions
•Cost per QALY Gained for Each Vaccination Strategy vs. No Vaccination
Q=Quadrivalent ( MenACWY ) vaccine; P=Pentavalent ( MenABCWY ) vaccine; IMD=Invasive meningococcal disease; QALY=Quality -adjusted life year.
Sensitivity Analysis 5a: Pentavalent Vaccine Price
36
a Note: 1/ The red arrow and dotted lines in each figure indicate the base case input and results, with the pentavalent vaccine priced at $211 per dose, resulting in
ICERs of $11 million/QALY and $4.5 million/QALY for each comparison, respectively. 2/ P -P is cost -saving compared to Q -Q when th e vaccine price is below $143.
3/ Q -P-P is cost -saving compared to Q -P-B when the vaccine price is below $190.Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine.
Cost -saving Cost -savingBase caseBase case
Comparison to GSK’s Model
37
•Incidence Rate:
•Higher in GSKb for MenACWY and MenB .
•Coverage Rate:
•Our model: Based on current coverage rates.
•GSK: Assumes 89% across vaccines and doses .CDC Model vs. GSK’sa: Differences in Model & Inputs
38a Note on conflict of interests: GSK manufacturers the GSK MenABCWY vaccine and the GSK MenB vaccine.
b Same as Ortega -Sanchez IR, ACIP presentation, June 2023 , using a longer pre -vaccine era.Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine.
•Vaccine Effectiveness (VE):
•Initial VE for 1st dose MenB : 64% (current model) vs. 33.5% ( GSKa).
•Duration of vaccine protection:
•In our model, VE declines to 0% in 5 -10 years.
•In GSK's model, VE declines to 0% after more than 20 years (both vaccines
maintain >20% effectiveness at 10 years and ~5% at 20 years).
•Years of protectionb conferred from MenACWY vaccination is 6.5 in our model
and 6.8 in the GSK modelc.
•Years of protectionb conferred from MenB vaccination is 3.6 years in our model
and 6.3 years in the GSK modeld.
•Sequelae:
•Current Model: 5 outcomes, aggregate probability per IMD case = 22%.
•GSKe: 16 outcomes, aggregate probability per IMD case = 55%.CDC Model vs. GSK’s: Differences in Model & Inputs
39a Argante et al . BMC Infectious Diseases. 2021 b Years of protection applies to those who were protected following 2 doses .
c Cohn AC et al . Pediatrics. 2017 d Kuylen et al . Presented at National Immunization Conference, Atlanta GA, 2024
e Marshall GS et al . Infect Dis Ther . 2024Q=Quadrivalent ( MenACWY ) vaccine; P=Pentavalent ( MenABCWY ) vaccine; IMD=Invasive meningococcal disease.
CDC Model vs. GSK’s: Differences in Outputs
PICO Intervention ComparatorICER ($/QALY)
CDC Model GSK Model
1 Q-P-B Q-QB-B Cost -savinga Cost -savinga
2 P-P Q-Q $11.3 million $15.6 million
3 Q-P-PQ-QB-B Cost -saving Cost -saving
Q-P-B $4.5 million $1.5 million•Cost -effectiveness of Intervention Strategy vs. Comparator Strategy
for 3 PICO Questions
40a In this comparison, costs are reduced, but health outcome remains the same when comparing Q -P-B to Q -QB-B.Q=Quadrivalent ( MenACWY ) vaccine; P=Pentavalent ( MenABCWY ) vaccine; QALY=Quality -adjusted life year.
•There are limited VE data, especially for the 2nd dose Q, and both doses of B. Input
values used in the model are based on immunogenicity data.
•The effectiveness of the 3rd dose of MenACWY (e.g., Q -P-P) is assumed to be the
same as the 2nd dose.
•Incidence rate in the absence of vaccination is unknown, we used the most recent
pre-vaccine era data in our study.
•The market price of GSK's pentavalent vaccine is not known with certainty; our
model used the same market cost as the GSK model.Limitations
41Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine.
•Not accounting for additional benefits of potential protection against gonorrhea.
-Possible benefits arise from changing from Q -Q to P -P , and from no vaccination vs. vaccination strategies.
•Not including potential increases in vaccine uptake, and fewer adverse events due
to fewer vaccine injections (i.e., P replacement of QB ).
•Vaccine coverage inputs in this version of the model are consistent with current
recommendations, age -based use of Q vaccines and shared clinical decision -making
(SCDM) use of B -component vaccines. Therefore, potential changes to the
SCDM/routine status of B -component vaccines were not incorporated into this
version of the model .Limitations
42Q=Quadrivalent ( MenACWY ) vaccine; B= MenB vaccine; P=Pentavalent ( MenABCWY ) vaccine.
•PICO 1:
-Q-P-B was found to be cost -saving relative to the current recommendation (vs. Q -QB-B).
•PICO 2:
-P-P could improve health outcomes, but costs $11.3 million per QALY saved (vs. Q -Q).
•PICO 3:
-Q-P-P could improve health outcomes, but estimated economic value varied depending on the
comparator:
•Q-P-P is cost -saving compared to Q -QB-B.
•Q-P-P costs $4.5 million per QALY gained more than Q -P-B.Summary
43Q=Quadrivalent ( MenACWY ) vaccine; P=Pentavalent ( MenABCWY ) vaccine; IMD=Invasive meningococcal disease; QALY=Quality -adjusted life year.
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TTY: 1 -888-232-6348 www.cdc.gov www.atsdr.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry.
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