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Men-C-Con vaccine more economical vs. Men-4-Con vaccine in Quebec
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Monovalent C meningococcal conjugate vaccine was a more economical option compared with a quadrivalent ACWY vaccine due to low epidemiologic factors for disease risk among children and adolescents in Quebec, according to a compartmental static simulation model.
However, the switch to a quadrivalent ACWY vaccine — Men-4-Con — would be more economical among Canadian provinces with an increased burden of disease.
“Currently, three monovalent and three quadrivalent products are licensed in Canada,” Philippe De Wals, MD, PhD, and Zhou Zhou, MD, PhD from the Centre de recherche du Centre hospitalier universitaire Québec, wrote. “Because of this, the price differential between the two types of vaccines has been greatly reduced and is now $10 to $15. An increasing number of provinces [and] territories are using Men-4-Con for the immunization of adolescents, reserving Men-C-Con for young children.”
De Wals and Zhou developed the compartmental static model to simulate the burden of serotypes A, W and Y invasive meningococcal disease with different vaccination programs. They assessed the economical efficiency of Men-C-Con and Men-4-Con for both health care and direct costs and productivity losses using a human capital approach among a birth cohort of 100,000 age-specific mortality rates that resembled those of Quebec. Further, the researchers expressed incremental cost-effectiveness ratios (ICERS) as Canadian dollars per quality-adjusted life-year gained ($/QALY), and $45,000/QALY was considered cost effective per the WHO Guide for standardization of economic evaluations of immunization programs.
The analysis indicated that the low-incidence base-case scenario (0.08/100,000 person-years) would see 10.1 AWY invasive meningococcal disease cases within the reference population. Switching Men-C-Con with Men-4-Con for adolescents for $12 per dose would reduce the burden of disease by 16% (no herd effect) to 58% (moderate herd effect), and ICERS would be between $445,000 and $167,000/QALY in terms of direct costs incurred by families and productivity losses.
Moreover, in the high-incidence base-case scenario (0.28/100,000; n = 35.4 cases in the cohort), ICERS would fall in the $19,000 to $97,000 range.
“In the situation of low incidence as observed in Quebec and many other Canadian provinces and territories, and with a price differential of $10 to $15 per dose, switching from Men-C-Con to Men-4-Con would not prevent many [invasive meningococcal disease] cases and ICERS would be above the traditional cost-effective benchmark of $45,000 per QALY,” the researchers wrote. “In provinces with a higher incidence, as in British Columbia or maybe Ontario, ICERS would be more favorable in scenarios with moderate to high herd effect.” – by Kate Sherrer
Disclosure: De Wals reports receiving research grants and reimbursements of travel expenses from vaccine manufacturers including GlaxoSmithKline, Novartis, Sanofi Pasteur and Pfizer.
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