| Abstrakt: |
Background and Objectives: In France, meningococcal serogroup B (MenB) is the most common serogroup causing invasive meningococcal disease (IMD) in infants and young children. Our objective was to illustrate the impact of model choices on health outcomes and the cost-effectiveness of infant vaccination with the multicomponent meningococcal serogroup B vaccine (4CMenB) versus no vaccine in France. Methods: A previously published dynamic transmission-based cost-effectiveness model was adapted for the French context using updated, French-specific demographic, epidemiological, and cost data. IMD incidence and long-term sequelae were derived through analysis of French healthcare and surveillance databases. A collective perspective over a 100-year time horizon was adopted, with a discount rate of 2.5%, reduced to 1.5% after the first 30 years. Deterministic and probabilistic sensitivity and scenario analyses were performed. Results: In the base case analysis, infant vaccination with 4CMenB avoided 3101 MenB IMD cases in infants aged < 1 year (− 54%) and 6845 cases in all age groups (− 21%). The estimated incremental cost-effectiveness ratio was €316,272/quality-adjusted life-year (QALY) but was highly sensitive to the types of sequelae included, MenB incidence, vaccine effectiveness parameters, and consideration of life-expectancy in IMD survivors (range: €65,272/QALY to €493,218/QALY). Conclusions: Using economic models compliant with French methodology guidelines, 4CMenB does not seem cost-effective; however, results are sensitive to model choices and 4CMenB immunization is an effective strategy to prevent MenB IMD cases and to improve quality of life and economic burden associated with MenB IMD treatment, especially with regard to long-term sequelae. Plain Language Summary: Invasive meningococcal disease (IMD) is rare but can lead to lifelong disabilities and death. It is caused by a type of bacteria called Neisseria meningitidis. IMD is most common in infants and young children, and in this group it is mostly caused by Neisseria serogroup B bacteria. We analyzed the number of IMD cases caused by serogroup B in France, as well as sequelae (long-time effects of the disease), using data from national healthcare databases. The most common sequelae observed were epilepsy, severe neurological disorders, and anxiety, occurring in approximately 5% of patients. We then calculated the costs and benefits of the multicomponent meningococcal serogroup B vaccine (4CMenB) vaccine for infants and young children in France. The results showed that 4CMenB vaccination can reduce the number of IMD cases due to serogroup B by 3101 cases (− 54%) in infants under 1 year and by 6845 cases (− 21%) in all age groups. Over 100 years, vaccination could prevent over 2000 cases of IMD that result in disabilities and 438 deaths. The estimated cost-effectiveness ratio was high. However, costs per health benefit gained decreased when focusing on long-term health benefits. In France, there is no threshold for the cost-effectiveness ratio and the French Health Authority has included 4CMenB in its vaccination schedule. This recommendation reflects results from our study, which highlights the considerable burden on families and patients, mostly because of IMD-related disabilities. Early vaccination is a good way to protect infants and young children against this serious disease. [ABSTRACT FROM AUTHOR] |
