Document text
The Cost -effectiveness of a Potential Pentavalent
Meningococcal Conjugate Vaccine (Men ABCWY)
versus the Current Men ACWY and Men B
vaccines for US Adolescents
Ismael R. Ortega -Sanchez, PhD
CDC/NCIRD
ACIP meeting, June 23, 2023
Disclaimer : 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. 1
2Conflict of Interest
CDC/NCIRD collaborators: All collaborators, No conflict of interest
•Ismael R Ortega -Sanchez
•Samuel James Crowe
•Lucy Alexandra McNamara
Acknowledgements
•Members of the Meningococcal ACIP working group
•Also, for review and comments provided by the economic team at ISD/NCIRD
Overview
•Policy question: Should the pentavalent vaccine (Men ABCWY) be
considered as an option for Men ACWY/Men B vaccination in people
currently recommended to receive both vaccines?
3Current vaccination Potential vaccination strategies
First dose Second dose First dose Second dose Third dose Key Label
At 11 -12 yrsold
with MenACWYAt 16 yrsold
with MenACWYAt 11 -12 yrsold with
MenACWYAt 16 yrsold with
MenABCWYAt 16 yrsold with
MenBQ-P-B
At 11 -12 yrsold with
MenABCWYAt 16 yrsold with
MenABCWYNone (N) P-P-N
At 16 yrs old
with Men BAt 16 yrsold
with Men BAt 11 -12 yrsold with
MenACWYAt 16 yrsold with
MenABCWYAt 16 yrsold with
MenABCWYQ-P-P
At 11 -12 yrsold with
MenABCWYAt 16 yrsold with
MenABCWYAt 16 yrsold with
MenABCWYP-P-P
Men ABCWY = Potential pentavalent vaccine (P) with serogroups A, B, C W Y
Men ACWY = currently recommended quadrivalent vaccine ( Q) for serogroups A, C, W, Y,
Men B =currently recommended monovalent vaccine for serogroup B
Economic analysis
Question : Is vaccinating adolescents 11 -16 years old with Pentavalent vaccine
series to prevent Invasive Meningococcal Disease in adolescents cost-effective ?
Comparator Interventions
Base -case scenario: What is the Incremental cost -effectiveness of vaccinating
healthy adolescents 11 -12 and 16 years old with Pentavalent vaccine relative to
using Men ACWY and Men B vaccines ?
4MenACWY vaccine: one
dose at 11 -12 years and
one dose at 16 years.
(Q-Q)
MenB vaccines: two
doses at 16 years.
(B-B)Use of Pentavalent
MenABCWY vaccine
combined e ither as
Q-P-B
P-P-N
Q-P-P
or P-P-P
Methods: Study question
Objectives :
•Toanalyze theimpact ofeach meningococcal vaccination strategy fortheprevention ofInvasive
Meningococcal Disease -related medical care, long-term sequalae and deaths among US
adolescents .
•Tocompare thehealth and cost impact associated with theuse ofpentavalent meningococcal
vaccine vs.current quadrivalent Men ACWY andMen Bmeningococcal vaccines, toestimate cost-
effectiveness interms ofhealth -related quality oflife,based oncurrently available data.
Perspective
•Base case ispresented from asocietal perspective, including
•Quality -of-lifeimpact tocases andindirect costs intheform ofproductivity lossandlifetime lost
earnings duetoaIMD-related acute disease, long-term sequelae ordeath .
5
Methods: Time frame and analytic horizon
Time frame and analytic horizon:
•Intervention time frame: cohort of 11yrs followed until 25yrs of age
•Meningococcal serogroup specific cases annually for 15 years
•Long term sequelae and death for 15 years
•Analytic horizon:
•Outcomes counted annually or cumulative for 15 year
•IMD disease long -term sequelae complications counted annually or cumulative for 15 years
•Lifetime medical and indirect cost of disabilities and deaths
Discounting:
•3% annual discount rate applied to cost and health outcomes .
6
Methods: the model
Static decision analytic model
•Able to track 11 -year-olds cohort yearly
with states that transition from
susceptibility, infected IMD, recovered
or death
•Monte Carlo simulations for uncertainty
and probabilistic sensitivity analyses
•Allowing pairwise incremental
comparison of hypothetical strategies
versus the standard of care
•Aggregating the associated IMD health
outcomes and costs
•With specific vaccination program
effectiveness, safety and costs
•For a cohort of 11 -year-olds followed for
15 years 7
recoveredvaccinated
Invasive Meningococcal
DiseaseNon-invasive
Disease
8Prevention of:
•IMD cases
•Associated sequelae
•Associated deaths
QALYs saved
$/Life year saved
$/QALY saved
NNV avert a:
•IMD case
•Complication
•DeathEpidemiologic
Data
Vaccine
Characteristics
Acute and
Long -term
Cost Data
Indirect
Cost
DataQuality
Of
Life
DataOther
Parameters
Cohort
ModelMethods: Inputs and main outcomes
9Epidemiologic Data
•Age-year -and B+C+Y+W serogroup -specific pre -vaccine and vaccine era
incidence rates
•1996 -2005 (pre -vaccine) and 2006 -2020 (“vaccine era” for serogroups CWY)
•1994 -2013 (pre -vaccine) and 2017 -2020 (“vaccine era” for serogroup B)
•Age-and serogroup -specific case fatality ratios
•Proportion of survivors with sequelae by condition
10Changes in the Average Annual Incidence in Vaccine Serogroups
BCYW by Age per 100,000
Source: Data from ABC Core Surveillance and NNDSS
Note: Trend and variability across years are used for range of uncertainties and sensitivity analyses •Rates of IMD disease
remain relatively
higher in late
adolescence, but in
general rates have
been declining for all
age groups.
•Overall, IMD
incidence rates are
one sixth of those
from recent pre -
vaccine era
0.000.200.400.600.801.001.201.401.60
=<10 11 12 13 14 15 16 17 18 19 20 21 22 >=23IMD incidence per 100,000
AgeCWY & B PreVaxs
CWY & B VaxsEra
11Background mortality and IMD Case Fatality Ratios by Age Group and
Serogroups CYW , Serogroup B and Serogroups BCWY *
*CFR data is from NNDSS for 2008 -202000.050.10.150.20.25
0-4m 5-11m 1yr 2- 4yrs 5-10yrs 11-17yrs 18-22yrs 23-32yrs 33-64yrs >=65yrsCase fatality rate of IMD
Age group B
C Y W
B C Y WAge (years) US mortality rates
(per 100,000)
11 12.5
12 14.8
13 18.6
14 24.2
15 32.2
16 43.0
17 56.4
18 71.7
19 84.4
20 94.1
21 102.7
22 109.1
23 114.8
24 119.9
25 125.3
26 131.1
All other causes, all races, both sexes from 2020
Lifetables, Social Security Agency
https://www.ssa.gov/oact/STATS/table4c6.html
12Percent of Survivor Cases with Sequelae by Type of
Condition
*Shepard et al. Pediatrics. 2005; 115:1220 -1232 https://pubmed.ncbi.nlm.nih.gov/15867028/
Ortega -Sanchez IR et al. Clin Infect Dis. 2008;46:1 -13 https://pubmed.ncbi.nlm.nih.gov/18171206/
**Edwards et al . J Pediatrics 1981; 99:540 -5 https://pubmed.ncbi.nlm.nih.gov/7277093/
*** Baraff et al . PIDJ 1993;12:389 -94 https://pubmed.ncbi.nlm.nih.gov/8327300/Skin scarring 7.6 (0 -19) Included*
Single amputation 1.9 (0.5 -10) Included*
Multiple amputations 1.2 (0.02 -6) Included*
Hearing loss** 8.8 (2 -20) Included*
Significant long term neurologic
disability***2.1 (0.02 -11) Included*
Initial vaccine effectiveness by vaccine and
serogroup
13QUADRIVALENT MEN B PENTAVALENT
Base -case Low High Base -case Low High Base -case Low High
First DOSE Men ACWY 93% 73% 98% 94% 62% 96%
2nd + DOSE Men ACWY 97% 73% 98% 97% 94% 99%
First DOSE Men B 60% -- -- 60%
2nd + DOSE Men B 85% 50% 99% 88% 79% 99%
Values and assumptions on initial protection are based on various sources:
Phase 3 noninferiority initial vaccine efficacy by single dose (at 11 -12yrs) and second -dose (16yrs) of pentavalent (Men ABCWY) vaccine as reported by Pfizer (data on
file).
Cohn AC, MacNeil JR, Harrison LH, et al. Active Bacterial Core Surveillance (ABCs) Team and MeningNet Surveillance Partners. Effectiveness and Duration of Protection
of One Dose of a Meningococcal Conjugate Vaccine. Pediatrics. 2017 Feb;139(2):e20162193. doi: 10.1542/peds.2016 -2193. PMID: 28100689; PMCID: PMC8353579.
0%20%40%60%80%100%120%
0 1 2 3 4 5 6 7 8Residual protection
Years after fully vaccinatedAssumption: Residual protection by vaccine
and serogroup
14Men ACWY Men B
Assumptions on residual protection are based on various sources:
•Sero -protection is assumed to persist 4 -5 years for a single dose of Men ACWY and Men ABCWY (based on hSBA sero bactericidal assay from Pfizer’s clinical trials report)
•Duration of protection ( DoP) for pentavalent Men ABCWY vaccines is assumed to follow Men ACWY
•Duration of protection ( DoP) for Men B is after fully immunized with 2 doses
•The pink -shaded areas denote a higher level of uncertainty of the waning assumption beyond available surveillance or Phase 3 dat a
•Cohn AC, MacNeil JR, Harrison LH, et al. Active Bacterial Core Surveillance (ABCs) Team and MeningNet Surveillance Partners. Effectiveness and Duration of Protection of One
Dose of a Meningococcal Conjugate Vaccine. Pediatrics. 2017 Feb;139(2):e20162193. doi: 10.1542/peds.2016 -2193. PMID: 28100689; PMCID: PMC8353579.0%20%40%60%80%100%120%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Residual Protection
Years after vaccination with first doseDoP 1st Dose Mean DoP 2nd Dose Mean
15Cost of vaccination per vaccine type, cost per
dose* and vaccine administration setting
* 2023 public and private sector cost per dose; VFC Current CDC Vaccine Price List, CDC. Although not included in these costs , rates and costs
of moderate and severe adverse event were taken from the UK experience with MCC
Trotter et al., BMJ 2002; Ortega -Sanchez et al., CID2008. They were applied to all vaccines
**Proportions of vaccine purchased at public and private sector and procurement from either private or private providers were based on
difference sources (i.e., Glazner et al., Pediatrics 2009)
*** Calculated using a hypothetical range of prices as released by Pfizer Inc. for Men ABCWY.Quadrivalent (Q) Men B (B) Pentavalent (P)
public sector cost for vaccine $105.6 $141.84 $230.0
public sector admin cost $15.0 $15.0 $15.0
private sector cost for vaccine $156.0 $211.32 $250.0
private sector admin cost $30.0 $30.0 $30.0
% vaccine purchased at public sector price 53.75% 53.75% 53.75%
% vaccine purchased at private sector price 46.25% 46.25% 46.25%
% vaccinations obtained from public health clinics 22% 22% 22%
% vaccinations obtained from private sector providers 78% 78% 78%
% vaccine waste 4.5% 4.5% 4.5%
Weighted cost per dose + administration$162.61
($128 -$191)$ 209.70
($155 -$250) $277.92***
($255 -$290)
16Other Benchmark Elements
Sources: Shepard et al. Pediatrics. 2005; 115:1220 -1232 https://pubmed.ncbi.nlm.nih.gov/15867028/
Ortega -Sanchez IR et al. Clin Infect Dis. 2008;46:1 -13 https://pubmed.ncbi.nlm.nih.gov/18171206/•Meningococcal disease incidence under vaccination
•Direct and Indirect costs of meningococcal disease
•Acute phase costs and long -term costs
•Productivity loss to deaths and sequelae
•Health related quality -of-life scores for estimating QALYs lost to sequelae
Program impact and cost -effectiveness then calculated by considering
Incremental Cost -effectiveness ratios
Monetary and quality -of-life costs associated with health outcomes
Cost of vaccination program including AEs
Quality of life outcomes
17Components of cost of illness calculation
OutcomeMed care
(mening )Parents’
Work -LossMed care
sequelaeLifetime care
(rehab, long term
care)**Productivity
Loss
No Sequelae (acute
phase√ √
Death √ √ √
Skin scarring √ √ √
Single amput √ √ √ √
Multi amput √ √ √ √ √
Hearing loss √ √ √ √
Neuro seq √ √ √ *** √Acute phase* Lifetime
*Includes caregivers' work time loss and public health response in outbreaks
** Includes special education for neurologic disability, prosthesis & rehabilitation for amputations, etc.
*** Significant neurologic disability lifetime medical costs were calculated and then annualized
Sources: Shepard et al. Pediatrics . 2005; 115:1220 -1232 https://pubmed.ncbi.nlm.nih.gov/15867028/
Ortega -Sanchez IR et al. Clin Infect Dis. 2008;46:1 -13 https://pubmed.ncbi.nlm.nih.gov/18171206/
Selected Cost of Meningococcal -Associated
Events*
Event / Cost Base -case Range for SA
Invasive meningococcal disease
Medical costs $48,983 $24,459 -$87,790
Public health response costs $13,547 $1,791 -$16,008
Value of work time lost by caregivers (acute phase) $4,160
Skin scarring
Medical care $7,436 $6,849 -$11,153
Single amputation
Medical care $23,050 $11,525 -$34,575
Other (prosthesis & rehabilitation) $180,446 $90,222 -$270,668
Value of permanent disability Age-specific
Multiple amputations
Medical care $27,662 $13,830 -$41,491
Other (prothesis & rehabilitation) $216,535 $108,267 -$324,802
Value of permanent disability Age-specific
Hearing loss
Medical care $89,566 $26,190 -$113,441
Value of permanent disability Age-specific
Long -term neurologic disability
Residential care $2,704,703 $923,013 -$3,288,152
Special education $204,014 $123,350 -$245,230
Value of permanent disability Age-specific
Premature death
11-17 yrs $1,657,326
18-24 yrs $1,734,664
* Costs were in 2022 US dollars and were adjusted for their social constant value in the economy using the Gross Domestic Pro duct (GDP) deflator.
Sources: various source and some unit costs were obtained after sequalae specific intermediate estimations 18
19Productivity Loss
•Incurred in cases with premature death or permanent sequelae:
•Acute phase
•Time of work missed Caregiver
•Death
•Labor market earnings + household production* Patient
•Neurologic sequelae
•Labor market earnings* Patient & caregiver
•Multiple amputations
•30% of labor market earnings** Patient
•Hearing loss
•33% of labor market earnings** Patient
*Reported in Grosse SD, et al . J Med Econ. 2019 Jun;22(6):501 -508.. https://pubmed.ncbi.nlm.nih.gov/30384792/
Values were adjusted to 2022 US$. Age -specific values, US population, 3% discount rate
** Shepard et al. Pediatrics . 2005; 115:1220 -1232 https://pubmed.ncbi.nlm.nih.gov/15867028/
Ortega -Sanchez IR et al. Clin Infect Dis. 2008;46:1 -13 https://pubmed.ncbi.nlm.nih.gov/18171206/
20Health -related Quality of Life QALY Scores*
Base case High Low
Baseline utilities 11 -25 years old ** 0.92
Survivor of IMD without sequalae (first year only) *** 0.91 0.88 0.94
Death 0
Skin scarring 0.95 1.00 0.80
Single amputation 0.70 0.80 0.31
Multiple amputations 0.61 0.71 0.31
Hearing loss/cochlear implants 0.72 0.82 0.64
Neurologic disability 0.06 0.39 0.00
*Several sources cited in: Shepard et al. Pediatrics . 2005; 115:1220 -1232 https://pubmed.ncbi.nlm.nih.gov/15867028/
Ortega -Sanchez IR et al. Clin Infect Dis. 2008;46:1 -13 https://pubmed.ncbi.nlm.nih.gov/18171206/
** Age -dependent EQ -5D-5L Utilities from Jiang, R. et al. Quality of Life Research, 2020:30, 803 -816. https://pubmed.ncbi.nlm.nih.gov/33025373/
*** Assumption based on hospitalization scores (unpublished data from a JIVE Covid utilities study. University of Michigan)
Note: Among survivors, except those without sequelae, the specific score’ reduction is applied for the remaining lifetime of survivor
21Disease Incidence Under Vaccination
For each age group and for each vaccination strategy
MDIvacc= MDIno vacc * [1 -VE*DoPt*Vcov ]
Where:
•MDIvacc = Meningococcal disease incidence under vaccination for each type of vaccine
•MDInovacc = Meningococcal disease incidence without vaccination
•VE = Initial v accine efficacy from each vaccine and dose
•DoPt = Duration of protection factor ( t= time in years after vaccination)
•Vcov = Vaccination coverage for each vaccine and dose
Economic evaluation
Incremental cost -effectiveness ratio ( ICER ) :
𝐼𝐶𝐸𝑅=𝑁𝐶𝑝𝑒𝑛𝑡𝑎−𝑁𝐶𝑆𝑜𝐶
𝐻𝑂𝑆𝑜𝐶−𝐻𝑂𝑝𝑒𝑛𝑡𝑎
Where:
•NCpenta = Net Cost of IMD disease with new interventions
(vaccine program costs)
•NCSoC = Net Cost of IMD disease costs under
Standard of care
•HOpenta = Health outcome using pentavalent (ex., QALYs)
•HOSoC = Health outcome of Standard of Care (ex., QALYs)
Both Cost and QALYs are discounted using:
•t = time years after immunization (t=0, 1, 2,…, T)
•r = discount rate (3%)
•T = Analytical horizon (age -specific, in years)Number needed to vaccinate (NNV) ratio :
𝑁𝑁𝑉=#𝑉𝑎𝑐𝑐𝑖𝑛𝑒𝑒𝑠
#𝐻𝑂𝑠𝑎𝑣𝑒𝑑
Where:
•# Vaccinees = Number of individuals vaccinated
against IMD during the time frame of the
intervention
•#HOsaved = Number of health outcomes saved or
prevented with vaccination, ex.,
•Acute IMD cases prevented
•Life-years prevented
•lives saved
23Results*
* Preliminary
Expected Cumulative Annual IMD Cases* and Deaths**
without vaccination in 11 –25-years old*
24120400
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26Cumulative number of IMD cases ( in logarithms )
Age in yearsMen ABCWY
Men ACWY
Men B
010203040506070
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26Cumulative number of IMD deaths
Age in yearsMen ABCWY
Men ACWY
Men B
* Using IMD incidence data from 1996 -2005 (pre -vaccine) for serogroups CWY and 1994 -2013 (pre -vaccine) for serogroup B
** Using CFR data is from NNDSS for 2008 -2020
Cumulative Number of IMD Cases Saved: Vaccination
strategy -and age -specific*
*Estimates from Monte Carlo Simulation
** Rounded to the nearest whole number25StrategyMean**
(5th& 95thpercentiles)
P-P-P229
(191 –273)
Q-P-B228
(190 –278)
P-P-N229
(189 –276)
Q-P-P226
(185 –270)
SoC207
(163 –252)
Q-Q194
(156 –241)
050100150200250300
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26Cumulative number of IMD cases saved by Vaccine
Age in yearsP-P-P
Q-P-B
P-P-N
Q-P-P
SoC
Q-Q
B-B
0510152025303540
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26Cumulative number of IMD deaths saved by Vaccine
Age in yearsP-P-P
Q-P-B
P-P-N
Q-P-P
SoC
Q-Q
B-BCumulative Number of IMD deaths prevented:
Vaccination strategy -and age -specific*
*Estimates from Monte Carlo Simulation
** Rounded to the nearest whole number26StrategyMean**
(5th, 95thpercentiles)
P-P-P32
(25 –40)
Q-P-B32
(25 –40)
P-P-N32
(25 –41)
Q-P-P31
(25 –40)
SoC30
(23 –37)
Q-Q27
(21 –36)
Number needed to vaccinated to prevent a case,
save a life, a life -year or a quality -adjusted life year
With
Men ACWY
(Q-Q)With Men B
(B-B) Q-P-B P-P-P
A IMD Case 19,034 292,559 16,144 16,085
A Death 133,981 1,810,451 115,450 115,086
A Life -year 4,644 63,695 4,763 4,745
A QALY 2,609 38,169 2,694 2,682
* Estimates from Monte Carlo Simulation
Men ABCWY = Potential pentavalent vaccine (P) with serogroups A, B, C ,W and Y
Men ACWY = Quadrivalent vaccine (Q) for serogroups A, C, W, and Y ,
Men B =Meningococcal serogroup B vaccine (B)
27
Baseline of SoC: Health outcomes, Vaccine and
Net Costs per ~4M Cohort, Mean (5th,95thPercentile)*
No Vaccine BCWYPrevention with
Men ACWY (Q -Q)
Vaccine & Net CostsPrevention with
Men B (B -B)
Vaccine & Net Costs SoC
IMD Cases428
(296 -604)194
(156 –241)13
(7 –21)207
Deaths68
(44 -95)28
(21 –36)2
(1 –4)30
Life years ***1,938
(1252 -2,701)796
(592 –1,035)58
(31 –98)854
QALY’s ***3,306
(3,084 -4,513)1,416
(1,090 –1,800)97
(53 –164)1,513
Vaccination program costs
(in Millions $) 0.0$1,120.4
(826.9 –1,471.5)$1,492.7
(1,061.2 –2,18.6)$2,613.0
Total net cost of illness
(in Millions $) ***$270
($178 -$379)$997.5
(667.0 –1,325.5)$1,485.0
(1,053.8 –2.011.3)$2,482.5
*Estimates from Monte Carlo Simulation
** Health outcomes were rounded to the nearest whole number
**Discounted at 3%28
Health outcomes saved and Net Cost per 4M Cohort of
11yrs followed until 25yrs: Mean (5th, 95thPercentile)*
SoCQ-P-B
(for Pico 1) P-P-P Q-QP-P-N
(for Pico 2)
IMD Cases207 229
(190 –278)229
(191 –273)194
(156 –241)229
(189 –276)
Deaths30 32
(25 –40)32
(25 –40)27
(21 –36)32
(25 –41)
Life years saved ***854 775
(585 –1,000)777
(584 –995)796
(590 –1,035)778
(577 –1,012)
QALY’s saved***1,513 1,370
(1,059 –1,7281,376
(1,065 –1,762)1,417
(1,090 –1,800)1,375
(1,058 –1,742)
Vaccination program
costs (in Millions $) $2,613.0 $2,129
(1,870 –2,425)$2,788.8
(2,602.5 –2,983)$1,120.4
(826.9 –1,472)$1,915.9
(1,788 –2,049)
Total net cost of illness
(in Millions $) ***$2,482.5 $1,986.4
(1,695 –2,265)$2,645.6
(2,469 –2,847)$968.2
(703.0 –1,348)$1,773
(1,643 –1,906)
29* Estimates from Monte Carlo Simulation
** Health outcomes were rounded to the nearest whole number
** Discounted at 3%
Incremental Cost per QALY saved by each vaccination
strategy when compared to No vaccination*
*Estimates from Monte Carlo Simulation, numbers were rounded to nearest thousand
The pink -shaded areas highlight comparison that would corroborate the incremental analysis results 30$550,000$17,082,000
$1,498,000
$1,126,000
100,0001,000,00010,000,000100,000,000
Q-Q B-B SoC P-P-NCost per QALY saved ( in logarithms )
$1,498,000
$1,290,000$1,517,000$1,775,000
700,0001,200,0001,700,0002,200,0002,700,000
SoC Q-P-B Q-P-P P-P-PCost per QALY saved$1,498,000$17,082,000
$550,000$1,126,000
100,0001,000,00010,000,000100,000,000
SoC B-B Q-Q P-P-NCost per QALY saved ( in logarithms )
Incremental Cost -Effectiveness Analyses for QALYs
and Life -years saved ( in thousands $ )
*Estimates from Monte Carlo Simulation (Discounted at 3%)
** the $/LY gained of P -P-N vs SoC strategy could be marginally cost-saving: Mean $/LY <0, but its 5thand 95thpercentiles from simulation range from <0 to costly
Note: SoC = Standard of care = one quadrivalent dose 11 -12yrs and second at 16yrs (= Q -Q) and2 doses Men B at 16yrs (= B -B)
Cost-saving = a strategy could be said to be dominant when is cost -saving 31Q-P-B vs. SoC
(Pico 1)P-P-P vs. SoCP-P-N vs. Q -Q
(Pico 2)
ICER QALY saved*Q-P-B
is cost -saving
(Cost <0)P-P-P is
incrementally costly
$1,455P-P-N
Is incrementally costly
$2,936
ICER LY saved*Q-P-B
is cost -saving
(Cost <0 ) P-P-P could be cost saving
(Cost ≤0)**
(Range from cost -saving to costly)P-P-N
is incrementally costly
$4,563 Q-P-B vs.
No vaccinationSoC vs
No vaccinationP-P-P vs
No vaccinationP-P-N vs.
No vaccinationQ-Q vs.
No vaccination
$/QALY saved*$1,256 $1,461 $1,730 $1,096 $534
$/ LY saved$2,563 $2,908 $3,401 $2,279 $1,254
Probability of Incremental Cost -Effectiveness ratio
per QALY saved: Q -P-B vs SoC: $/QALY<0 (Pico 1)
32-8.12 -0.58
5.0% 5.0% 90.0%
0.00.20.40.60.81.0
-10
-8
-6
-4
-2
0
2
4
6
Values in Millions ($)Q-P-B-vs-SoC: Cumulative Probability of ICER per QALY saved*
*Estimates from Monte Carlo Simulation using a sample of 1000 iterations (Costs were discounted at 3%)
Range are 5thand 95thpercentiles •Both 5thand 95th
percentiles are
negative (i.e., cost
saving)
•More than 95% of the
iterations were
negative (i.e., cost
saving)
Sensitivity of Incremental Cost -Effectiveness ratio per
QALY saved: P -P-N vs Q -Q $2.9M/QALY gained (Pico 2)
33
34Strengths and Limitations
Strengths
•Complex modeling
•Explicit use of incidence and CFR surveillance data for Men BCWY vaccine -
containing serogroups
Limitations
•Data on vaccine effectiveness from pentavalent Men BCWY are from clinical trials
•Hard to ascertain decrease in IMD incidence rates due to natural decline trend vs.
vaccine induced decline
•Variability of vaccine uptake per type of vaccine
35Conclusions
•Disease rates and vaccine cost drive the incremental analyses
•Although additional cases could be prevented by all vaccination
strategies, they do it at different costs per health outcome
•Most strategies with one or more doses of the Men ABCWY vaccine would
save more or equal number of cases, but they do at a much higher costs per
QALY saved when compared to the standard of care.
•The exception is the Q -P-B, which included one dose of Men ABCWY in
substitution of the second dose of Men ACWY and first dose of Men B.
•Q-P-B could be incrementally cost -saving (ICER QALY <0) relative to the
standard of care
•Using last 10 years of epidemiology data and current (or proposed)
vaccine prices increase the cost of all strategies compared to previous
analyses
End of Presentation
Incidence rate of IMD for serogroups CWY 1996 -
2005 and 1996 -2020 by age per 100,000
0.000.200.400.600.801.001.201.401.60
=<10 11 12 13 14 15 16 17 18 19 20 21 22 >=23IMD incidence rate for serogroups CWY per 100,000
AgeMean CWY 1996-2005
Median CWY 1996-2005
Mean CWY 1996-2020
Median CWY1996-2020
Incidence rates from 1996 -2005 for the Pre vaccine Era are from the ABC core surveillance
Incidence rates from 1996 to 2020 combined data from ABC and NNDSS. 37
Incidence rate of IMD for serogroup B before
and during vaccine era by age per 100,000
00.050.10.150.20.250.30.35
11-12 years 13-14 years 15-16 years 17-18 years 19-20 years 21-22 years 23-24 yearsIMD incidence rate for serogroup B per 100,000
AgeABC-1994-2013
2014-2016
2017-2019
2020-2022 Pre
Data from 1994 -2013 are from the ABC core surveillance, Data from 2014 -2019 are from the NNDSS.
Data from 2020 -2022 also from NNDSS is preliminary 38
Incidence rate of IMD for serogroups CWY before
and during vaccine era by age per 100,000
0.010.101.0010.00
=<10 11 12 13 14 15 16 17 18 19 20 21 22 >=23IMD incidence per 100,000(n logarithms)
AgeMean CWY 1996-2005
Median CWY 1996-2005
Mean CWY 2005-2020
Median CYW 2005-2020
39