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Re-evaluating cost effectiveness of universal meningitis vaccination (Bexsero) in England: modelling study

BMJ 2014; 349 doi: (Published 09 October 2014) Cite this as: BMJ 2014;349:g5725
  1. Hannah Christensen, research associate1,
  2. Caroline L Trotter, senior lecturer2,
  3. Matthew Hickman, professor of public health and epidemiology1,
  4. W John Edmunds, professor of infectious disease modelling3
  1. 1School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
  2. 2Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
  3. 3London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  1. Correspondence to: H Christensen hannah.christensen{at}
  • Accepted 22 August 2014


Objective To use mathematical and economic models to predict the epidemiological and economic impact of vaccination with Bexsero, designed to protect against group B meningococcal disease, to help inform vaccine policy in the United Kingdom.

Design Modelling study.

Setting England.

Population People aged 0-99.

Interventions Incremental impact of introductory vaccine strategies simulated with a transmission dynamic model of meningococcal infection and vaccination including potential herd effects. Model parameters included recent evidence on the vaccine characteristics, disease burden, costs of care, litigation costs, and loss of quality of life from disease, including impacts on family and network members. The health impact of vaccination was assessed through cases averted and quality adjusted life years (QALYs) gained.

Main outcome measures Cases averted and cost per QALY gained through vaccination; programmes were deemed cost effective against a willingness to pay of £20 000 (€25 420, $32 677) per QALY gained from an NHS and personal and social services perspective.

Results In the short term, case reduction is greatest with routine infant immunisation (26.3% of cases averted in the first five years). This strategy could be cost effective at £3 (€3.8, $4.9) a vaccine dose, given several favourable assumptions and the use of a quality of life adjustment factor. If the vaccine can disrupt meningococcal transmission more cases are prevented in the long term with an infant and adolescent combined programme (51.8% after 30 years), which could be cost effective at £4 a vaccine dose. Assuming the vaccine reduces acquisition by 30%, adolescent vaccination alone is the most favourable strategy economically, but takes more than 20 years to substantially reduce the number of cases.

Conclusions Routine infant vaccination is the most effective short term strategy and could be cost effective with a low vaccine price. Critically, if the vaccine reduces carriage acquisition in teenagers, the combination of infant and adolescent vaccination could result in substantial long term reductions in cases and be cost effective with competitive vaccine pricing.


  • We thank the following individuals for providing data and assistance: Mary Ramsay, Shamez Ladhani, and Iain Kennedy (Public Health England); Hareth Al-Janabi (University of Birmingham); Charlotte Chamberlain and Laura Clark (University of Bristol); Julie Mills (Office for National Statistics); and Guy Walker (Department of Health). The hospital episode statistics data were made available by the NHS Health and Social Care Information Centre. Copyright © 2013. Re-used with the permission of the Health and Social Care Information Centre. All rights reserved.

  • Contributors: All authors were involved in the conception and design of the research. HC, CLT, and JE developed the models; HC analysed and all authors interpreted the results. HC wrote the first draft of the manuscript; all authors drafted the final version of the manuscript. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. HC and WJE are guarantors.

  • Funding: This work was supported by the Department of Health and the National Institute for Health Research (NIHR) (RDA/03/07/014 and PDF-2012-05-245 to HC, PDA/02/06/088 to CT). This work is produced by the authors under the terms of these research training fellowships issued by the NIHR. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. MH is a member of the NIHR School of Public Health Research; HC and MH are members of the NIHR Health Protection Research Unit Evaluation of Interventions. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that HC, MH, and WJE have support from the Department of Health for the submitted work.

  • Ethical approval: Not required.

  • Transparency declaration: The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

  • Data sharing: Details of the model data inputs and other assumptions are provided in the methods and supporting parameters table. Researchers interested in further details of the model can contact the corresponding author.

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