Cost-Effectiveness of Alternative Uses of Polyvalent Meningococcal Vaccines in Niger: An Agent-Based Transmission Modeling Study

S. M. Niaz Arifin, Christoph Zimmer, Caroline Trotter, Anaïs Colombini, Fati Sidikou, F. Marc LaForce, Ted Cohen and Reza Yaesoubi
Additional contact information
S. M. Niaz Arifin: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
Christoph Zimmer: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
Caroline Trotter: Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
Anaïs Colombini: independent consultant, Madagascar
Fati Sidikou: Centre de Recherche Medicale et Sanitaire (CERMES), Niamey, NE, Niger
F. Marc LaForce: Serum Institute of India, Pune
Ted Cohen: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
Reza Yaesoubi: Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA

Medical Decision Making, 2019, vol. 39, issue 5, 553-567

Abstract: Background. Despite the introduction of an effective serogroup A conjugate vaccine (MenAfriVac™), sporadic epidemics of other Neisseria meningitidis serogroups remain a concern in Africa. Polyvalent meningococcal conjugate (PMC) vaccines may offer alternatives to current strategies that rely on routine infant vaccination with MenAfriVac plus, in the event of an epidemic, district-specific reactive campaigns using polyvalent meningococcal polysaccharide (PMP) vaccines. Methods. We developed an agent-based transmission model of N. meningitidis in Niger to compare the health effects and costs of current vaccination practice and 3 alternatives. Each alternative replaces MenAfriVac in the infant vaccination series with PMC and either replaces PMP with PMC for reactive campaigns or implements a one-time catch up campaign with PMC for children and young adults. Results. Over a 28-year period, replacement of MenAfriVac with PMC in the infant immunization series and of PMP in reactive campaigns would avert 63% of expected cases (95% prediction interval 49%–75%) if elimination of serogroup A is not followed by serogroup replacement. At a PMC price of $4/dose, this would cost $1412 ($81–$3510) per disability-adjusted life-year (DALY) averted. If serogroup replacement occurs, the cost-effectiveness of this strategy improves to $662 (cost-saving, $2473) per DALY averted. Sensitivity analyses accounting for incomplete laboratory confirmation suggest that a catch-up PMC campaign would also meet standard cost-effectiveness thresholds. Limitations. The assumption that polyvalent vaccines offer similar protection against all serogroups is simplifying. Conclusions. The use of PMC vaccines to replace MenAfriVac in routine infant immunization and in district-specific reactive campaigns would have important health benefits and is likely to be cost-effective in Niger. An additional PMC catch-up campaign would also be cost-effective if we account for incomplete laboratory reporting.

Keywords: economic evaluation; meningitis; meningococcal; simulation; vaccine (search for similar items in EconPapers)
Date: 2019
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://journals.sagepub.com/doi/10.1177/0272989X19859899 (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:39:y:2019:i:5:p:553-567

DOI: 10.1177/0272989X19859899

Access Statistics for this article

More articles in Medical Decision Making
Bibliographic data for series maintained by SAGE Publications ().