Cost-effectiveness analysis of vaccination strategies against meningococcal disease for children under nine years of age in China

ABSTRACT

Meningococcal vaccination strategies in China are intricate, including multiple vaccines targeting different serogroups. The current National Immunization Program (NIP) includes two polysaccharide vaccines for serogroups A and C (MPV-A and MPV-AC), covering limited serogroups and requiring adaptation. This study aims to evaluate the cost-effectiveness of replacing the current strategy with alternative strategies utilizing non-NIP vaccines to inform policy decisions. From a societal perspective, a decision tree-Markov model was constructed to simulate the economic and health consequences of meningococcal disease in a 2019 birth cohort with four vaccination strategies. Epidemiology, vaccine efficacy, cost, and other parameters were derived from previous studies. We conducted sensitivity analyses to assess the robustness of the findings and explored prices for non-NIP vaccines that enable cost-effective strategies. Compared to the current strategy, alternative strategies using quadrivalent polysaccharide vaccine (MPV-4), bivalent conjugate vaccine (MCV-AC), and quadrivalent conjugate vaccine (MCV-4) could avoid 91, 286, and 455 more meningococcal cases. The ICERs were estimated at approximately $250 thousand/QALY, $450 thousand/QALY, and $1.5 million/QALY, all exceeding the threshold of three times GDP per capita. The alternative strategies were not cost-effective. However, if vaccine prices were reduced to $3.9 for MPV-4, $9.9 for MCV-AC, and $12 for MCV-4, the corresponding strategy would be cost-effective. The current meningococcal vaccination strategy in China could effectively prevent the disease at a low cost, but with limited serogroup coverage. Strategies using MPV-4, MCV-AC, or MCV-4 could increase health benefits at a substantial cost, and might become cost-effective if vaccine prices decrease.

KEYWORDS:

• Meningococcal disease
• vaccination strategies
• meningococcal vaccines
• cost-effectiveness analysis
• economic evaluation
• China

Highlights

• Evidencebefore this study

Many studies examining various meningococcal vaccination strategies in different countries have been published. In China, three studies have been conducted at provincial level to evaluate the current strategy with MPV-A and MPV-AC in the NIP. All three studies concluded that the current strategy was economically favorable. However, no studies have been conducted at the national level to evaluate the alternative strategies using non-NIP vaccines, and no comparison has been performed between alternative strategies and the current strategy.

• Addedvalue of this study

This study represents a pioneering effort in evaluating the cost-effectiveness of various meningococcal vaccination strategies on a national scale in China with modeling. We compared the alternative strategies using MPV-4, MCV-AC, and MCV-4 with the current strategy adopted by the NIP. We also investigated the level to which the price of the non-NIP vaccines must decrease, under current epidemiological circumstances, in order to render their inclusion in NIP cost-effective.

• Implicationsof all the available evidence

In preventing meningococcal disease in China, replacing the current NIP vaccines with non-NIP vaccines could further prevent cases, and the strategy with MCV-4 could deliver the greatest health benefits. However, from a societal perspective, universal supply of non-NIP vaccines to children without charge is not cost-effective due to high prices of non-NIP vaccines. The prices of non-NIP vaccines might be decreased to facilitate inclusion in the NIP, and this would enable more cost-effective strategies.

Author’s contributions

HZ (Haonan Zhang) developed the specific study protocol, constructed the model for cost effectiveness analysis and wrote the first draft of the manuscript. HZ (Haijun Zhang) collaborated in the study protocol and in the construction and refinement of the model. HZ (Haonan Zhang) and HZ (Haijun Zhang) contributed to the collection of data required for the input parameters. HF initiated the study design, supervised the project, and directed the analysis and manuscript writing. All authors have carefully revised the draft of the manuscript.

Disclosure statement

HF reports a grant from the Bill & Melinda Gates Foundation (INV-034554). The rest of the authors declare no competing interests.

Data availability statement

The detailed data source for the model inputs are available in the article, and most parameter inputs are based on published data. The complete model structure and specific data used in the study are available upon request to the corresponding author.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website at https://doi.org/10.1080/21645515.2024.2313872.

Additional information

Funding

Bill & Melinda Gates Foundation (INV-034554)