In the Journals

Universal MenB vaccination of college-aged adults not cost-effective

Universally vaccinating young adults entering college with the meningococcal B vaccine is not cost-effective because of the rarity of Neisseria meningitidis serogroup B, or MenB, study findings showed.

Writing in the American Journal of Preventive Medicine, researchers from Johns Hopkins University noted that MenB is the most prevalent form of meningococcal infection in individuals aged 16 to 23 years, but also that rates of meningococcal disease have plummeted by more than 75% over the last decade. The FDA has approved two MenB vaccines for use in the United States, including one that may offer cross-protection against gonorrhea, according to recent findings.

MenB vaccines are effective only over the short term because their immunogenicity wanes over time, the researchers noted. For their study, they sought to determine whether universal vaccination of college-aged individuals is cost-effective from health sector and societal perspectives compared with outbreak-only vaccination, in which college students, faculty and staff would be belatedly vaccinated in response to a campus outbreak.

The authors used the model of a hypothetical 4-year liberal arts college in the U.S. with 1,000 students per class and 4,000 faculty and staff. Each student entering college at the age of 18 years was assumed to have equal risk for developing MenB infection for 4 years, and zero risk after leaving college.

To evaluate the cost-effectiveness from a societal perspective, the researchers estimated lost productivity attributed to premature death or long-term disability from sequelae of MenB infection. The cost-effectiveness from a health perspective was based on the medical costs of individual and third-party payers over 4 years. Each perspective was compared with a willingness-to-pay threshold of $150,000 per quality-adjusted life year (QALY).

“The incremental cost per quality-adjusted life year gained with universal vaccination was $13.9 million under the health sector perspective and $13.8 million under the societal perspective,” the researchers wrote. “Multivariable probabilistic sensitivity analysis showed that universal vaccination was not the preferred strategy for [less than] $15 million per quality-adjusted life year. Under an extremely favorable model, a universal vaccination strategy became cost effective for vaccine series costing [less than] $65.”

The researchers concluded that although MenB vaccines are safe and effective over the short term, the low incidence of infection combined with the high cost of universal vaccination of college-aged young adults makes having no formal vaccination program the most cost-effective strategy. However, they acknowledged that universal vaccination may be needed if epidemiologic surveillance finds an increase in infections among college-aged individuals. – by Erin Michael

Disclosures: The researchers report no relevant financial disclosures.

Universally vaccinating young adults entering college with the meningococcal B vaccine is not cost-effective because of the rarity of Neisseria meningitidis serogroup B, or MenB, study findings showed.

Writing in the American Journal of Preventive Medicine, researchers from Johns Hopkins University noted that MenB is the most prevalent form of meningococcal infection in individuals aged 16 to 23 years, but also that rates of meningococcal disease have plummeted by more than 75% over the last decade. The FDA has approved two MenB vaccines for use in the United States, including one that may offer cross-protection against gonorrhea, according to recent findings.

MenB vaccines are effective only over the short term because their immunogenicity wanes over time, the researchers noted. For their study, they sought to determine whether universal vaccination of college-aged individuals is cost-effective from health sector and societal perspectives compared with outbreak-only vaccination, in which college students, faculty and staff would be belatedly vaccinated in response to a campus outbreak.

The authors used the model of a hypothetical 4-year liberal arts college in the U.S. with 1,000 students per class and 4,000 faculty and staff. Each student entering college at the age of 18 years was assumed to have equal risk for developing MenB infection for 4 years, and zero risk after leaving college.

To evaluate the cost-effectiveness from a societal perspective, the researchers estimated lost productivity attributed to premature death or long-term disability from sequelae of MenB infection. The cost-effectiveness from a health perspective was based on the medical costs of individual and third-party payers over 4 years. Each perspective was compared with a willingness-to-pay threshold of $150,000 per quality-adjusted life year (QALY).

“The incremental cost per quality-adjusted life year gained with universal vaccination was $13.9 million under the health sector perspective and $13.8 million under the societal perspective,” the researchers wrote. “Multivariable probabilistic sensitivity analysis showed that universal vaccination was not the preferred strategy for [less than] $15 million per quality-adjusted life year. Under an extremely favorable model, a universal vaccination strategy became cost effective for vaccine series costing [less than] $65.”

The researchers concluded that although MenB vaccines are safe and effective over the short term, the low incidence of infection combined with the high cost of universal vaccination of college-aged young adults makes having no formal vaccination program the most cost-effective strategy. However, they acknowledged that universal vaccination may be needed if epidemiologic surveillance finds an increase in infections among college-aged individuals. – by Erin Michael

Disclosures: The researchers report no relevant financial disclosures.