London School of Hygiene & Tropical Medicine

The research, published in the BMJ, analysed how to maximise the reduction in cases while making a new vaccination programme cost-effective. Bexsero is the first vaccine to broadly protect against meningitis B disease, but the study now suggests that the Government would need to negotiate a considerable reduction in the £75 list price in order to provide the same value for money as other programmes in the NHS.

In March 2014, the Joint Committee on Vaccination and Immunisation (JCVI), the independent expert group that advises UK governments on vaccination, recommended that Bexsero be offered to babies at two, four and 12 months of age, as long as the Department of Health can obtain the vaccine at a cost-effective price.

Researchers at the London School of Hygiene & Tropical Medicine and Universities of Bristol and Cambridge, estimated the potential impact of a vaccine on cases of meningitis and septicaemia and the cost-effectiveness of a range of immunisation programmes.

Their analysis took into account a range of factors, including how many cases could be averted, the cost of care, litigation costs, the quality of life for those left with disabilities, and the impact on families. The costs and benefits of vaccination over people's lifetimes were compared to the costs and losses of not introducing it.

For the first time, the research also estimated what price the vaccine should be in the UK as part of the decision making process.

Professor John Edmunds, senior author from the London School of Hygiene & Tropical Medicine, and colleagues said in their paper: "Our results suggest that routine infant vaccination could be cost effective in England under favourable assumptions if the vaccine could be procured at less than 20% of the list price. This is the most favourable option because it targets those most at risk of disease... Surveillance after implementation will be crucial to determining the true effectiveness of the vaccine."

Several vaccine strategies were considered, targeting infants where incidence is high and adolescents where transmission is thought to be the greatest.

Researchers also considered a range of different scenarios of how well the vaccine might work protecting against infection and disease, as well as the impact of the disease in the population.

The study estimates 1,447 cases of all meningococcal disease and 59 deaths occur annually in the absence of vaccination against group B meningococcal disease.

Cases would be cut by 26% in the first five years if the recommended vaccination programme at two four and 12 months is followed.  This could be cost-effective with the vaccine priced at £7 per dose, given several favourable assumptions and the use of a quality of life adjustment factor.

Maximum reduction will be achieved by combining infant vaccination with an adolescent vaccination at 13-years-old. This would see annual cases reduced by 49% in 10 years and 60% in 20 years, but is dependent upon the vaccine protecting against carriage as well as disease, which is uncertain.

Assuming the vaccine works as well as possible, covering 91% of meningitis B strains and preventing 60% of carriage to save more lives, the maximum price of the vaccine for it to remain cost-effective would be £22 a dose to be given at two, four and 12 months.

Campaigners have been calling for the vaccine to be introduced in the UK since it was licensed in Europe in January 2013, but cost has always been a key issue.

The research was supported by the National Institute for Health Research.

Publication

• Hannah Christensen, Caroline L Trotter, Matthew Hickman and W John Edmunds. Re-evaluating the cost-effectiveness of universal 'MenB' (Bexsero) vaccination in England: a modelling study. The BMJ. DOI: 10.1136/bmj.g5725