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. 2022 Jul;22(7):1030–1041. doi: 10.1016/S1473-3099(21)00744-1

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© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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Impact of 4CMenB vaccination over 10 years, how the cost per dose affects the probability of vaccination being cost-effective, and cost-effectiveness efficiency frontiers comparing targeting strategies

(A) Cases of gonorrhoea in men who have sex with men in England following introduction of vaccination in 2022 under different targeting strategies (VoD, VaR, and VoA) using the 4CMenB vaccine, assuming the vaccine is 1, 1·5, 2, or 2·5 times as protective as the MeNZB vaccine, and has durations of protection after primary vaccination and re-vaccination as estimated by the Joint Committee on Vaccination and Immunisation for protection of infants against serogroup B meningococcal disease (ie, 18 months after two-dose primary vaccination and 36 months after re-vaccination). Lines represent medians and shaded regions represent 95% credible intervals. (B) Probability that vaccination is cost-effective (ie, its value exceeds its cost) with the same vaccine efficacies and durations of protection as in panel A. Vertical dashed lines show two alternative costs per dose of 4CMenB administered: £18, corresponding to the estimated National Health Service price of £8 per dose plus the £10 administration cost; or £85, corresponding to the current UK list price of £75 plus the £10 administration cost. (C) Cost-effectiveness efficiency frontiers comparing the three targeting strategies if 4CMenB is as protective as MeNZB, the durations of protection are the same as in panels A and B, and the cost per dose administered is £18 or £85. The black line shows the frontier, the numbered circles show the mean incremental costs and QALYs for each strategy, and the individual points show the uncertainty represented by the 1000 sets of sampled epidemiological and health-economic parameters. In all panels vaccine uptake is 33·0% (95% CI 32·7–33·3). Note that panel A shows undiscounted numbers while panel C shows discounted values. QALY=quality-adjusted life-year. VoD=vaccination on diagnosis. VaR=vaccination according to risk. VoA=vaccination on attendance.