Cost-Effectiveness of Routine Infant Meningococcal B Vaccination in the Netherlands

Invasive meningococcal disease (IMD) is a severe infectious disease that can cause mortality and debilitating sequelae. IMD is typically vaccine-preventable. In the Netherlands, meningococcal serogroup B (MenB) causes almost all IMD cases. The objective of this study was to assess the cost-effectiveness of routine infant MenB vaccination in the Netherlands, using the latest incidence data, real-world evidence and vaccine data. We used the dynamic transmission cost-effectiveness (DyCE) model to compare routine infant vaccination with three doses of the four-component meningococcal B vaccine (4CMenB) versus no MenB vaccination, from a societal perspective. The model followed 100 cohorts over lifetime, was updated with the most recent Dutch epidemiological evidence, and was adapted in accordance with the latest Dutch health economic guidelines. Additionally, IMD incidence was varied in scenario analyses to model the unpredictable incidence of MenB IMD and potential outbreaks of this disease. Over lifetime, 2367 MenB IMD cases, 1077 long-term sequelae cases and 116 deaths were prevented with 4CMenB vaccination in the base case. 4CMenB vaccination saved 14,703 quality-adjusted life years (QALYs), predominantly by preventing long-term sequelae (45.5%) and deaths (52.2%). The incremental cost-effectiveness ratio (ICER) was €99,752 per QALY gained in the base case and decreased below the willingness-to-pay threshold of 80,000 if the IMD incidence increased by 24%, or if the vaccine acquisition costs decreased by 22% (from €78.5 to €61.45). The ICER was most sensitive to variations in vaccine effectiveness, the incidence of MenB IMD and vaccine acquisition costs. In the Netherlands, 4CMenB vaccination is likely to be cost-effective if MenB incidence increases by 24%. This comprehensive analysis provides decision-makers with new and updated information on the cost-effectiveness of infant vaccination with 4CMenB in the Netherlands. In the Netherlands, Neisseria meningitidis serogroup B (MenB) is the leading cause of invasive meningococcal disease, with an incidence that is cyclic but difficult to predict. Although vaccines are available to prevent infection with MenB, they are not currently included in the Dutch National Immunisation Programme. A previous analysis from 2013 showed that vaccination against MenB in the Netherlands was not cost-effective. However, since then, new data on the MenB vaccine and the disease burden of invasive meningococcal disease have become available. The current study provides an updated analysis of the cost-effectiveness of infant vaccination against MenB in the Netherlands, using the dynamic transmission-based cost-effectiveness model. Over a lifelong runtime of 100 cohorts, the model predicts that vaccination of infants with 4CMenB would prevent 2367 invasive meningococcal disease cases, 1077 long-term sequelae cases and 116 deaths. In the Netherlands, infant vaccination with 4CMenB is likely to become cost-effective if the number of MenB cases increases by 24% or if the vaccine acquisition costs decreases by 22%.