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Cost-Effectiveness of Alternative Uses of Polyvalent Meningococcal Vaccines in Niger: An Agent-Based Transmission Modeling Study

Author

Listed:
  • S. M. Niaz Arifin

    (Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA)

  • Christoph Zimmer

    (Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA)

  • Caroline Trotter

    (Department of Veterinary Medicine, University of Cambridge, Cambridge, UK)

  • Anaïs Colombini

    (independent consultant, Madagascar)

  • Fati Sidikou

    (Centre de Recherche Medicale et Sanitaire (CERMES), Niamey, NE, Niger)

  • F. Marc LaForce

    (Serum Institute of India, Pune)

  • Ted Cohen

    (Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA)

  • Reza Yaesoubi

    (Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA)

Abstract

Background. Despite the introduction of an effective serogroup A conjugate vaccine (MenAfriVac™), sporadic epidemics of other Neisseria meningitidis serogroups remain a concern in Africa. Polyvalent meningococcal conjugate (PMC) vaccines may offer alternatives to current strategies that rely on routine infant vaccination with MenAfriVac plus, in the event of an epidemic, district-specific reactive campaigns using polyvalent meningococcal polysaccharide (PMP) vaccines. Methods. We developed an agent-based transmission model of N. meningitidis in Niger to compare the health effects and costs of current vaccination practice and 3 alternatives. Each alternative replaces MenAfriVac in the infant vaccination series with PMC and either replaces PMP with PMC for reactive campaigns or implements a one-time catch up campaign with PMC for children and young adults. Results. Over a 28-year period, replacement of MenAfriVac with PMC in the infant immunization series and of PMP in reactive campaigns would avert 63% of expected cases (95% prediction interval 49%–75%) if elimination of serogroup A is not followed by serogroup replacement. At a PMC price of $4/dose, this would cost $1412 ($81–$3510) per disability-adjusted life-year (DALY) averted. If serogroup replacement occurs, the cost-effectiveness of this strategy improves to $662 (cost-saving, $2473) per DALY averted. Sensitivity analyses accounting for incomplete laboratory confirmation suggest that a catch-up PMC campaign would also meet standard cost-effectiveness thresholds. Limitations. The assumption that polyvalent vaccines offer similar protection against all serogroups is simplifying. Conclusions. The use of PMC vaccines to replace MenAfriVac in routine infant immunization and in district-specific reactive campaigns would have important health benefits and is likely to be cost-effective in Niger. An additional PMC catch-up campaign would also be cost-effective if we account for incomplete laboratory reporting.

Suggested Citation

  • S. M. Niaz Arifin & Christoph Zimmer & Caroline Trotter & Anaïs Colombini & Fati Sidikou & F. Marc LaForce & Ted Cohen & Reza Yaesoubi, 2019. "Cost-Effectiveness of Alternative Uses of Polyvalent Meningococcal Vaccines in Niger: An Agent-Based Transmission Modeling Study," Medical Decision Making, , vol. 39(5), pages 553-567, July.
    • Handle: RePEc:sae:medema:v:39:y:2019:i:5:p:553-567
    DOI: 10.1177/0272989X19859899
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    References listed on IDEAS

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    1. Independent Evaluation Group, 2017. "Data for Development," World Bank Publications - Books, The World Bank Group, number 28485.
    2. Reza Yaesoubi & Caroline Trotter & Caroline Colijn & Maziar Yaesoubi & Anaïs Colombini & Stephen Resch & Paul A Kristiansen & F Marc LaForce & Ted Cohen, 2018. "The cost-effectiveness of alternative vaccination strategies for polyvalent meningococcal vaccines in Burkina Faso: A transmission dynamic modeling study," PLOS Medicine, Public Library of Science, vol. 15(1), pages 1-18, January.
    3. Joël Mossong & Niel Hens & Mark Jit & Philippe Beutels & Kari Auranen & Rafael Mikolajczyk & Marco Massari & Stefania Salmaso & Gianpaolo Scalia Tomba & Jacco Wallinga & Janneke Heijne & Malgorzata Sa, 2008. "Social Contacts and Mixing Patterns Relevant to the Spread of Infectious Diseases," PLOS Medicine, Public Library of Science, vol. 5(3), pages 1-1, March.
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