BMJ 2002;324:809 ( 6 April )

Papers

Modelling cost effectiveness of meningococcal serogroup C conjugate vaccination campaign in England and Wales

Caroline L Trotter, research scientist, ^a W John Edmunds, research fellow. ^b

^a Immunisation Division, PHLS Communicable Disease Surveillance Centre, London NW9 5EQ, ^b Department of Economics, City University, London EC1V 0HB

Correspondence to: C Trotter ctrotter{at}phls.org.uk

Objectives: To assess the cost effectiveness of a meningococcal serogroup C conjugate vaccination campaign in 0-17 year olds.
Design: Cost effectiveness analysis from the perspective of the healthcare provider.
Setting: England and Wales.
Main outcome measure: Cost per life year saved.
Results: In 1998-9, immediately before the introduction of meningococcal C vaccination, the burden of serogroup C disease was considerable, with an estimated 1137 cases in people aged 0-17 years and at least 72 deaths. The vaccination campaign is estimated to have cost between £126m ($180m, 207m) and £241m ($343m, 395m), depending on the price of the vaccine. Under base case assumptions the cost per life year saved from the vaccination campaign is estimated to be £6259. School based vaccination was more cost effective than general practice based vaccination because of lower delivery costs. Immunisation of infants aged under 1 year was the least cost effective component of the campaign because, although this maximises the life years gained, the three dose schedule required is more expensive than other methods of delivery. Estimates of the cost per life year saved were sensitive to assumptions on the future incidence of disease and the case fatality ratio.
Conclusions: Meningococcal C vaccination is likely to be more cost effective in all age groups when the incidence of disease is high. It is also more cost effective when given to children aged 1-4 (by general practitioners) and to children and young people aged 5-17 years at school than when administered to infants under 12 months of age or young people aged 16-17 years who are not at school.

What is already known on this topic The burden of group C meningococcal disease in England and Wales in the late 1990s was considerable In November 1999 the United Kingdom was the first country to introduce mass vaccination against group C meningococcal disease There are no published economic evaluations of the vaccination campaign What this study adds This economic evaluation supports the introduction of the meningococcal C vaccine School based vaccination is more cost effective than routine vaccination of infants because delivery costs are lower and fewer doses are required

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