Letters Universal meningitis vaccination

Potential long term vaccine benefits poorly translate in cost effectiveness modelling

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6764 (Published 13 November 2014) Cite this as: BMJ 2014;349:g6764
  1. Steven Black, professor of pediatrics and infectious diseases1
  1. 1Center for Global Health, Cincinnati Children’s Hospital, Cincinnati, OH, USA
  1. stevblack{at}gmail.com

Christensen and colleagues’ study highlights the difficulties and inappropriateness of basing decisions solely on cost effectiveness models when uncertainty cannot be quantified.1 Vaccines are particularly prone to uncertainty regarding impact because serotype coverage and herd immunity can be difficult or impossible to assess in pre-licensure trials. The fact that this publication marks the third adaptation of the Joint Committee on Vaccination and Immunisation (JCVI) meningitis B model attests to these difficulties.

The cost effectiveness estimate for PCV7 was unfavourable ($80 000 (£50 480; €64 464)/quality adjusted life year (QALY)), although the vaccine was highly cost effective ($7500/QALY) when introduced.2 In the UK, the herd immunity benefits of the meningitis …

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