Cost-benefit Analysis of Meningococcal Vaccine
Vaccinating first-year college students living in dormitories for Meningococcal disease: an economic analysis. Scott RD, II , Meltzer MI, Erickson LJ, De Wals P, and Rosenstein NE. American Journal of Preventive Medicine 2002;23(2):98-105.
Explanatory note: Neisseria meningitidis, or the meningococcus, is a bacterium that can cause a rapidly developing, life-threatening infection of the bloodstream, meningitis (infection of the brain and spinal cord coverings), or both. Infection can cause many deaths and survivors can be permanently damaged. The need for amputations is not uncommon among survivors, despite good medical care. Meningococcal disease is most common in infants but there is not yet a vaccine available for the most common strain or for use in infants.
There is a licensed vaccine that is 80-90% effective for two thirds of the strains causing infections among older children and adults.
First-year college students who live in dormitories have an elevated risk of meningococcal disease. One study found that among 18 to 23-year-olds who did not attend college, there were 1.4 cases of meningitis per 100,000 people; freshmen living in dormitories had a much higher rate of the disease when compared with other students, 5.4 cases per 100,000.
What would be the costs and benefits of routinely vaccinating U.S. first-year college students living in dormitories against meningococcal disease?
In this study, researchers conducted an economic analysis using a cost-benefit model to determine what would be the costs and benefits for society of a hypothetical immunization program using the presently US licensed vaccine.
The immunization program would have vaccinated 591,587 first-year students living in dormitories during the 1998–1999 school year. In the absence of vaccination, an estimated 30 cases of vaccine-preventable meningococcal disease would be expected leading to 3 deaths and 3 cases with permanent sequelae over a 4 year period, most cases occurring during the first year.
The benefits of averting disease through vaccination include the treatment-cost savings; averting a premature death; and the cost savings of averting disease-related sequelae. Program costs included costs of vaccine, vaccine administration, and vaccine-related side effects.
Researchers calculated the costs using five different scenarios: low, intermediate, high, worst, and best.
In every scenario considered in the study, the costs outweighed the benefits, with economic losses between $11 million and $49 million.
The model in this study found that the low number of cases that could be prevented with the vaccine and the high cost of vaccination would not make the immunization program cost-saving.
The relevance/bottom line
This economic analysis showed that a publicly funded program to vaccinate first-year students living in dormitories against meningococcal disease will result in a net economic loss to society. However, because meningococcal disease can cause serious health problems and even death, students and their parents may be willing to pay for vaccination.
Parents whose children have had this infection, survivors, public health officials, and many health providers would argue that an economic analysis under estimates the real impact of this illness. For example, this analysis did not estimate the cost of public health interventions that result when a case of meningococcal disease occurs in a community.
Further, as mentioned by the authors, the study did not attempt to value the intense fear and anxiety associated with such cases. A number of states and colleges require in-coming college freshman to be immunized against N. meningitidis because of how devastating the disease can be.
Potentially more effective vaccines are under development and these may prove to be more cost effective, in part because they not only protect vaccinated individuals but may also protect the community at large by decreasing circulation of the meningococcus.
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