The Cost-effectiveness of a Potential Pentavalent 

Meningococcal Conjugate Vaccine (Men ABCWY) 

versus the Current Men ACWY and Men B 

vaccines for US Adolescents 

Ismael R. Ortega-Sanchez, PhD

CDC/NCIRD

ACIP meeting, June 23, 2023

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily 

represent the views of the Centers for Disease Control and Prevention. 

1
2

Conflict of Interest

CDC/NCIRD collaborators: All collaborators, No conflict of interest

• Ismael R Ortega-Sanchez 

• Samuel James Crowe

• Lucy Alexandra McNamara

Acknowledgements

• Members of the Meningococcal ACIP working group

• Also, for review and comments provided by the economic team at ISD/NCIRD
Overview

• Policy question: Should the pentavalent vaccine (Men ABCWY) be 

considered as an option for Men ACWY/Men B vaccination in people 

currently recommended to receive both vaccines?

3

Current vaccination Potential vaccination strategies

First dose Second dose First dose Second dose Third dose Key Label

At 11-12 yrs old

with MenACWY

At 16 yrs old

with MenACWY

At 11-12 yrs old with 

MenACWY

At 16 yrs old with

MenABCWY

At 16 yrs old with 

MenB Q-P-B

At 11-12 yrs old with 

MenABCWY

At 16 yrs old with 

MenABCWY None (N) P-P-N

At 16 yrs old 

with Men B

At 16 yrs old 

with Men B

At 11-12 yrs old with 

MenACWY

At 16 yrs old with

MenABCWY

At 16 yrs old with

MenABCWY Q-P-P

At 11-12 yrs old with 

MenABCWY

At 16 yrs old with

MenABCWY

At 16 yrs old with

MenABCWY P-P-P

Men ABCWY = Potential pentavalent vaccine (P) with serogroups A, B, C W Y 

Men ACWY = currently recommended quadrivalent vaccine (Q) for serogroups A, C, W, Y, 

Men B =currently recommended monovalent vaccine for serogroup B
Economic analysis

Question: Is vaccinating adolescents 11-16 years old with Pentavalent vaccine 

series to prevent Invasive Meningococcal Disease in adolescents cost-effective?

Comparator Interventions

Base-case scenario: What is the Incremental cost-effectiveness of vaccinating 

healthy adolescents 11-12 and 16 years old with Pentavalent vaccine relative to 

using Men ACWY and Men B vaccines ?

4

MenACWY vaccine: one 

dose at 11-12 years and 

one dose at 16 years. 

(Q-Q)

MenB vaccines: two 

doses at 16 years. 

(B-B)

Use of Pentavalent 

MenABCWY vaccine 

combined either as

Q-P-B

P-P-N

Q-P-P

or P-P-P
Methods: Study question

Objectives:

• To analyze the impact of each meningococcal vaccination strategy for the prevention of Invasive

Meningococcal Disease-related medical care, long-term sequalae and deaths among US

adolescents.

• To compare the health and cost impact associated with the use of pentavalent meningococcal

vaccine vs. current quadrivalent Men ACWY and Men B meningococcal vaccines, to estimate costeffectiveness in terms of health-related quality of life, based on currently available data.

Perspective

• Base case is presented from a societal perspective, including

• Quality-of-life impact to cases and indirect costs in the form of productivity loss and lifetime lost

earnings due to a IMD-related acute disease, long-term sequelae or death.

5
Methods: Time frame and analytic horizon

Time frame and analytic horizon: 

• Intervention time frame: cohort of 11yrs followed until 25yrs of age 

• Meningococcal serogroup specific cases annually for 15 years

• Long term sequelae and death for 15 years

• Analytic horizon: 

• Outcomes counted annually or cumulative for 15 year

• IMD disease long-term sequelae complications counted annually or cumulative for 15 years

• Lifetime medical and indirect cost of disabilities and deaths 

Discounting:

• 3% annual discount rate applied to cost and health outcomes.

6
Methods: the model

Static decision analytic model 

• Able to track 11-year-olds cohort yearly 

with states that transition from 

susceptibility, infected IMD, recovered 

or death

• Monte Carlo simulations for uncertainty 

and probabilistic sensitivity analyses 

• Allowing pairwise incremental 

comparison of hypothetical strategies 

versus the standard of care 

• Aggregating the associated IMD health 

outcomes and costs 

• With specific vaccination program 

effectiveness, safety and costs

• For a cohort of 11-year-olds followed for 

15 years 7

recovered

vaccinated

Invasive Meningococcal 

Disease

Non-invasive 

Disease
8

Prevention of:

• IMD cases

• Associated sequelae

• Associated deaths

QALYs saved

$/Life year saved

$/QALY saved

NNV avert a: 

• IMD case

• Complication

• Death

Epidemiologic 

Data

Vaccine

Characteristics

Acute and

Long-term 

Cost Data

Indirect 

Cost

Data

Quality

Of

Life

Data

Other 

Parameters

Cohort 

Model

Methods: Inputs and main outcomes
9

Epidemiologic Data

• Age- year- and B+C+Y+W serogroup-specific pre-vaccine and vaccine era 

incidence rates 

• 1996-2005 (pre-vaccine) and 2006-2020 (“vaccine era” for serogroups CWY) 

• 1994-2013 (pre-vaccine) and 2017-2020 (“vaccine era” for serogroup B)

• Age- and serogroup-specific case fatality ratios 

• Proportion of survivors with sequelae by condition
10

Changes in the Average Annual Incidence in Vaccine Serogroups 

BCYW by Age per 100,000

Source: Data from ABC Core Surveillance and NNDSS

Note: Trend and variability across years are used for range of uncertainties and sensitivity analyses 

• Rates of IMD disease 

remain relatively 

higher in late 

adolescence, but in 

general rates have 

been declining for all 

age groups.

• Overall, IMD 

incidence rates are 

one sixth of those 

from recent prevaccine era 

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

=<10 11 12 13 14 15 16 17 18 19 20 21 22 >=23

IMD incidence per 100,000

Age

CWY & B PreVaxs

CWY & B VaxsEra
11

Background mortality and IMD Case Fatality Ratios by Age Group and 

Serogroups CYW, Serogroup B and Serogroups BCWY *

* CFR data is from NNDSS for 2008-2020

0

0.05

0.1

0.15

0.2

0.25

0-4m 5-11m 1yr 2- 4yrs 5-10yrs 11-17yrs 18-22yrs 23-32yrs 33-64yrs >=65yrs

Case fatality rate of IMD

Age group 

B

C Y W

B C Y W

Age (years) 

US mortality rates 

(per 100,000)

11 12.5

12 14.8

13 18.6

14 24.2

15 32.2

16 43.0

17 56.4

18 71.7

19 84.4

20 94.1

21 102.7

22 109.1

23 114.8

24 119.9

25 125.3

26 131.1

All other causes, all races, both sexes from 2020 

Lifetables, Social Security Agency

https://www.ssa.gov/oact/STATS/table4c6.html
12

Percent of Survivor Cases with Sequelae by Type of 

Condition

* Shepard et al. Pediatrics. 2005; 115:1220-1232 https://pubmed.ncbi.nlm.nih.gov/15867028/

Ortega-Sanchez IR et al. Clin Infect Dis. 2008;46:1-13 https://pubmed.ncbi.nlm.nih.gov/18171206/

**Edwards et al. J Pediatrics 1981; 99:540-5 https://pubmed.ncbi.nlm.nih.gov/7277093/

*** Baraff et al. PIDJ 1993;12:389-94 https://pubmed.ncbi.nlm.nih.gov/8327300/

Skin scarring 7.6 (0 - 19) Included*

Single amputation 1.9 (0.5 - 10) Included*

Multiple amputations 1.2 (0.02 - 6) Included*

Hearing loss** 8.8 (2 - 20) Included*

Significant long term neurologic 

disability***

2.1 (0.02 - 11) Included*
Initial vaccine effectiveness by vaccine and 

serogroup

13

QUADRIVALENT MEN B PENTAVALENT

Base-case Low High Base-case Low High Base-case Low High

First DOSE Men ACWY 93% 73% 98% 94% 62% 96%

2nd + DOSE Men ACWY 97% 73% 98% 97% 94% 99%

First DOSE Men B 60% -- -- 60%

2nd + DOSE Men B 85% 50% 99% 88% 79% 99%

Values and assumptions on initial protection are based on various sources:

Phase 3 noninferiority initial vaccine efficacy by single dose (at 11-12yrs) and second-dose (16yrs) of pentavalent (Men ABCWY) vaccine as reported by Pfizer (data on 

file).

Cohn AC, MacNeil JR, Harrison LH, et al. Active Bacterial Core Surveillance (ABCs) Team and MeningNet Surveillance Partners. Effectiveness and Duration of Protection 

of One Dose of a Meningococcal Conjugate Vaccine. Pediatrics. 2017 Feb;139(2):e20162193. doi: 10.1542/peds.2016-2193. PMID: 28100689; PMCID: PMC8353579.
0%

20%

40%

60%

80%

100%

120%

0 1 2 3 4 5 6 7 8

Residual protection

Years after fully vaccinated

Assumption: Residual protection by vaccine 

and serogroup

14

Men ACWY Men B 

Assumptions on residual protection are based on various sources:

• Sero-protection is assumed to persist 4-5 years for a single dose of Men ACWY and Men ABCWY (based on hSBA sero bactericidal assay from Pfizer’s clinical trials report)

• Duration of protection (DoP) for pentavalent Men ABCWY vaccines is assumed to follow Men ACWY

• Duration of protection (DoP) for Men B is after fully immunized with 2 doses 

• The pink-shaded areas denote a higher level of uncertainty of the waning assumption beyond available surveillance or Phase 3 data

• Cohn AC, MacNeil JR, Harrison LH, et al. Active Bacterial Core Surveillance (ABCs) Team and MeningNet Surveillance Partners. Effectiveness and Duration of Protection of One 

Dose of a Meningococcal Conjugate Vaccine. Pediatrics. 2017 Feb;139(2):e20162193. doi: 10.1542/peds.2016-2193. PMID: 28100689; PMCID: PMC8353579.

0%

20%

40%

60%

80%

100%

120%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Residual Protection 

Years after vaccination with first dose

DoP 1st Dose Mean DoP 2nd Dose Mean
15

Cost of vaccination per vaccine type, cost per 

dose* and vaccine administration setting

* 2023 public and private sector cost per dose; VFC Current CDC Vaccine Price List, CDC. Although not included in these costs, rates and costs 

of moderate and severe adverse event were taken from the UK experience with MCC

Trotter et al., BMJ 2002; Ortega-Sanchez et al., CID 2008. They were applied to all vaccines

**Proportions of vaccine purchased at public and private sector and procurement from either private or private providers were based on 

difference sources (i.e., Glazner et al., Pediatrics 2009)

*** Calculated using a hypothetical range of prices as released by Pfizer Inc. for Men ABCWY.

Quadrivalent (Q) Men B (B) Pentavalent (P)

public sector cost for vaccine $105.6 $141.84 $230.0

public sector admin cost $15.0 $15.0 $15.0

private sector cost for vaccine $156.0 $211.32 $250.0

private sector admin cost $30.0 $30.0 $30.0

% vaccine purchased at public sector price 53.75% 53.75% 53.75%

% vaccine purchased at private sector price 46.25% 46.25% 46.25%

% vaccinations obtained from public health clinics 22% 22% 22%

% vaccinations obtained from private sector providers 78% 78% 78%

% vaccine waste 4.5% 4.5% 4.5%

Weighted cost per dose + administration $162.61 

($128 - $191)

$ 209.70 

($155 - $250) 

$277.92***

($255 - $290) 
16

Other Benchmark Elements

Sources: Shepard et al. Pediatrics. 2005; 115:1220-1232 https://pubmed.ncbi.nlm.nih.gov/15867028/

Ortega-Sanchez IR et al. Clin Infect Dis. 2008;46:1-13 https://pubmed.ncbi.nlm.nih.gov/18171206/

• Meningococcal disease incidence under vaccination

• Direct and Indirect costs of meningococcal disease

• Acute phase costs and long-term costs

• Productivity loss to deaths and sequelae

• Health related quality-of-life scores for estimating QALYs lost to sequelae

Program impact and cost-effectiveness then calculated by considering

Incremental Cost-effectiveness ratios 

Monetary and quality-of-life costs associated with health outcomes

Cost of vaccination program including AEs

Quality of life outcomes 
17

Components of cost of illness calculation

Outcome

Med care

(mening)

Parents’ 

Work-Loss

Med care 

sequelae

Lifetime care 

(rehab, long term 

care)**

Productivity 

Loss

No Sequelae (acute 

phase

√ √

Death √ √ √

Skin scarring √ √ √

Single amput √ √ √ √

Multi amput √ √ √ √ √

Hearing loss √ √ √ √

Neuro seq √ √ √ *** √

Acute phase* Lifetime

* Includes caregivers' work time loss and public health response in outbreaks

** Includes special education for neurologic disability, prosthesis & rehabilitation for amputations, etc.

*** Significant neurologic disability lifetime medical costs were calculated and then annualized

Sources: Shepard et al. Pediatrics. 2005; 115:1220-1232 https://pubmed.ncbi.nlm.nih.gov/15867028/

Ortega-Sanchez IR et al. Clin Infect Dis. 2008;46:1-13 https://pubmed.ncbi.nlm.nih.gov/18171206/
Selected Cost of Meningococcal-Associated 

Events*

Event / Cost Base-case Range for SA

Invasive meningococcal disease

Medical costs $48,983 $24,459 - $87,790

Public health response costs $13,547 $1,791 - $16,008

Value of work time lost by caregivers (acute phase) $4,160

Skin scarring

Medical care $7,436 $6,849 - $11,153

Single amputation

Medical care $23,050 $11,525 - $34,575

Other (prosthesis & rehabilitation) $180,446 $90,222 - $270,668

Value of permanent disability Age-specific

Multiple amputations

Medical care $27,662 $13,830 - $41,491 

Other (prothesis & rehabilitation) $216,535 $108,267 - $324,802

Value of permanent disability Age-specific

Hearing loss

Medical care $89,566 $26,190 - $113,441

Value of permanent disability Age-specific

Long-term neurologic disability 

Residential care $2,704,703 $923,013 - $3,288,152

Special education $204,014 $123,350 - $245,230

Value of permanent disability Age-specific

Premature death 

11-17 yrs $1,657,326

18-24 yrs $1,734,664

* Costs were in 2022 US dollars and were adjusted for their social constant value in the economy using the Gross Domestic Product (GDP) deflator. 

Sources: various source and some unit costs were obtained after sequalae specific intermediate estimations 

18
19

Productivity Loss

• Incurred in cases with premature death or permanent sequelae:

• Acute phase 

• Time of work missed Caregiver

• Death 

• Labor market earnings + household production* Patient 

• Neurologic sequelae

• Labor market earnings* Patient & caregiver

• Multiple amputations

• 30% of labor market earnings** Patient

• Hearing loss

• 33% of labor market earnings** Patient

* Reported in Grosse SD, et al. J Med Econ. 2019 Jun;22(6):501-508.. https://pubmed.ncbi.nlm.nih.gov/30384792/

Values were adjusted to 2022 US$. Age-specific values, US population, 3% discount rate

** Shepard et al. Pediatrics. 2005; 115:1220-1232 https://pubmed.ncbi.nlm.nih.gov/15867028/

Ortega-Sanchez IR et al. Clin Infect Dis. 2008;46:1-13 https://pubmed.ncbi.nlm.nih.gov/18171206/
20

Health-related Quality of Life QALY Scores*

Base case High Low

Baseline utilities 11-25 years old ** 0.92

Survivor of IMD without sequalae (first year only) *** 0.91 0.88 0.94

Death 0

Skin scarring 0.95 1.00 0.80

Single amputation 0.70 0.80 0.31

Multiple amputations 0.61 0.71 0.31

Hearing loss/cochlear implants 0.72 0.82 0.64

Neurologic disability 0.06 0.39 0.00

* Several sources cited in: Shepard et al. Pediatrics. 2005; 115:1220-1232 https://pubmed.ncbi.nlm.nih.gov/15867028/

Ortega-Sanchez IR et al. Clin Infect Dis. 2008;46:1-13 https://pubmed.ncbi.nlm.nih.gov/18171206/

** Age-dependent EQ-5D-5L Utilities from Jiang, R. et al. Quality of Life Research, 2020:30, 803 - 816. https://pubmed.ncbi.nlm.nih.gov/33025373/

*** Assumption based on hospitalization scores (unpublished data from a JIVE Covid utilities study. University of Michigan)

Note: Among survivors, except those without sequelae, the specific score’ reduction is applied for the remaining lifetime of survivor 
21

Disease Incidence Under Vaccination

For each age group and for each vaccination strategy

MDIvacc = MDIno vacc * [1 - VE*DoPt*Vcov]

Where:

• MDIvacc = Meningococcal disease incidence under vaccination for each type of vaccine

• MDIno vacc = Meningococcal disease incidence without vaccination

• VE = Initial vaccine efficacy from each vaccine and dose

• DoPt = Duration of protection factor (t = time in years after vaccination)

• Vcov = Vaccination coverage for each vaccine and dose
Economic evaluation

Incremental cost-effectiveness ratio (ICER) : 

ICER =

NCpenta − NCSoC

HOSoC − HOpenta

Where:

• NCpenta = Net Cost of IMD disease with new interventions 

(vaccine program costs)

• NCSoC = Net Cost of IMD disease costs under 

Standard of care

• HOpenta = Health outcome using pentavalent (ex., QALYs)

• HOSoC = Health outcome of Standard of Care (ex., QALYs) 

Both Cost and QALYs are discounted using:

• t = time years after immunization (t=0, 1, 2,..., T)

• r = discount rate (3%)

• T = Analytical horizon (age-specific, in years)

Number needed to vaccinate (NNV) ratio: 

NNV =

# Vaccinees

# HOsaved

Where:

• # Vaccinees = Number of individuals vaccinated 

against IMD during the time frame of the 

intervention

• #HOsaved = Number of health outcomes saved or 

prevented with vaccination, ex., 

• Acute IMD cases prevented

• Life-years prevented

• lives saved
23

Results*

* Preliminary
Expected Cumulative Annual IMD Cases* and Deaths** 

without vaccination in 11–25-years old*

24

1

20

400

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Cumulative number of IMD cases (in logarithms) 

Age in years

Men ABCWY

Men ACWY

Men B

0

10

20

30

40

50

60

70

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Cumulative number of IMD deaths 

Age in years

Men ABCWY

Men ACWY

Men B

* Using IMD incidence data from 1996-2005 (pre-vaccine) for serogroups CWY and 1994-2013 (pre-vaccine) for serogroup B

** Using CFR data is from NNDSS for 2008-2020
Cumulative Number of IMD Cases Saved: Vaccination 

strategy- and age-specific*

* Estimates from Monte Carlo Simulation

** Rounded to the nearest whole number

25

Strategy Mean** 

(5th & 95th percentiles)

P-P-P

229 

(191 – 273)

Q-P-B

228 

(190 – 278)

P-P-N

229 

(189 – 276)

Q-P-P

226

(185 – 270)

SoC 207

(163 – 252)

Q-Q

194 

(156 – 241)

0

50

100

150

200

250

300

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Cumulative number of IMD cases saved by Vaccine

Age in years

P-P-P

Q-P-B

P-P-N

Q-P-P

SoC

Q-Q

B-B
0

5

10

15

20

25

30

35

40

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Cumulative number of IMD deaths saved by Vaccine

Age in years

P-P-P

Q-P-B

P-P-N

Q-P-P

SoC

Q-Q

B-B

Cumulative Number of IMD deaths prevented: 

Vaccination strategy- and age- specific*

* Estimates from Monte Carlo Simulation

** Rounded to the nearest whole number

26

Strategy Mean** 

(5th, 95th percentiles)

P-P-P

32 

(25 – 40)

Q-P-B

32 

(25 – 40)

P-P-N

32 

(25 – 41)

Q-P-P

31

(25 – 40)

SoC 30

(23 – 37)

Q-Q

27 

(21 – 36)
Number needed to vaccinated to prevent a case, 

save a life, a life-year or a quality-adjusted life year

With

Men ACWY 

(Q-Q)

With Men B

(B-B) Q-P-B P-P-P

A IMD Case 19,034 292,559 16,144 16,085

A Death 133,981 1,810,451 115,450 115,086

A Life-year 4,644 63,695 4,763 4,745

A QALY 2,609 38,169 2,694 2,682

* Estimates from Monte Carlo Simulation

Men ABCWY = Potential pentavalent vaccine (P) with serogroups A, B, C ,W and Y

Men ACWY = Quadrivalent vaccine (Q) for serogroups A, C, W, and Y, 

Men B =Meningococcal serogroup B vaccine (B)

27
Baseline of SoC: Health outcomes, Vaccine and 

Net Costs per ~4M Cohort, Mean (5th ,95th Percentile)*

No Vaccine BCWY

Prevention with

Men ACWY (Q-Q) 

Vaccine & Net Costs

Prevention with 

Men B (B-B)

Vaccine & Net Costs SoC

IMD Cases

428

(296 - 604)

194

(156 – 241)

13

(7 – 21)

207

Deaths

68

(44 - 95)

28

(21 – 36)

2

(1 – 4)

30

Life years ***

1,938

(1252 - 2,701)

796

(592 – 1,035)

58

(31 – 98)

854

QALY’s ***

3,306

(3,084 - 4,513)

1,416

(1,090 – 1,800)

97

(53 – 164)

1,513

Vaccination program costs 

(in Millions $) 0.0

$1,120.4 

(826.9 – 1,471.5)

$1,492.7 

(1,061.2 – 2,18.6)

$2,613.0

Total net cost of illness 

(in Millions $) ***

$270 

($178-$379)

$997.5 

(667.0 – 1,325.5)

$1,485.0 

(1,053.8 – 2.011.3)

$2,482.5

* Estimates from Monte Carlo Simulation

** Health outcomes were rounded to the nearest whole number 

** Discounted at 3%

28
Health outcomes saved and Net Cost per 4M Cohort of 

11yrs followed until 25yrs: Mean (5th, 95th Percentile)*

SoC

Q-P-B

(for Pico 1) P-P-P Q-Q

P-P-N

(for Pico 2)

IMD Cases

207 229

(190 – 278)

229

(191 – 273)

194

(156 – 241)

229

(189 – 276)

Deaths

30 32

(25 – 40)

32

(25 – 40)

27

(21 – 36)

32

(25 – 41)

Life years saved ***

854 775

(585 – 1,000)

777

(584 – 995)

796

(590 – 1,035)

778

(577 – 1,012)

QALY’s saved***

1,513 1,370

(1,059 – 1,728

1,376

(1,065 – 1,762)

1,417

(1,090 – 1,800)

1,375

(1,058 – 1,742)

Vaccination program 

costs (in Millions $) 

$2,613.0 $2,129

(1,870 – 2,425)

$2,788.8 

(2,602.5 – 2,983)

$1,120.4 

(826.9 – 1,472)

$1,915.9

(1,788 – 2,049)

Total net cost of illness 

(in Millions $) ***

$2,482.5 $1,986.4 

(1,695 – 2,265)

$2,645.6 

(2,469 – 2,847)

$968.2 

(703.0 – 1,348)

$1,773

(1,643 – 1,906)

29

* Estimates from Monte Carlo Simulation

** Health outcomes were rounded to the nearest whole number 

** Discounted at 3%
Incremental Cost per QALY saved by each vaccination 

strategy when compared to No vaccination*

* Estimates from Monte Carlo Simulation, numbers were rounded to nearest thousand

The pink-shaded areas highlight comparison that would corroborate the incremental analysis results 30

$550,000

$17,082,000

$1,498,000

$1,126,000

100,000

1,000,000

10,000,000

100,000,000

Q-Q B-B SoC P-P-N

Cost per QALY saved (in logarithms)

$1,498,000

$1,290,000

$1,517,000

$1,775,000

700,000

1,200,000

1,700,000

2,200,000

2,700,000

SoC Q-P-B Q-P-P P-P-P

Cost per QALY saved

$1,498,000

$17,082,000

$550,000

$1,126,000

100,000

1,000,000

10,000,000

100,000,000

SoC B-B Q-Q P-P-N

Cost per QALY saved (in logarithms)
Incremental Cost-Effectiveness Analyses for QALYs 

and Life-years saved (in thousands $)

* Estimates from Monte Carlo Simulation (Discounted at 3%)

** the $/LY gained of P-P-N vs SoC strategy could be marginally cost-saving: Mean $/LY <0, but its 5th and 95th percentiles from simulation range from <0 to costly

Note: SoC = Standard of care = one quadrivalent dose 11-12yrs and second at 16yrs (= Q-Q) and 2 doses Men B at 16yrs (= B-B)

Cost-saving = a strategy could be said to be dominant when is cost-saving 31

Q-P-B vs. SoC

(Pico 1) P-P-P vs. SoC P-P-N vs. Q-Q(Pico 2)

ICER QALY saved*

Q-P-B 

is cost-saving 

(Cost <0)

P-P-P is 

incrementally costly

$1,455

P-P-N 

Is incrementally costly

$2,936

ICER LY saved*

Q-P-B

is cost-saving 

(Cost <0) 

P-P-P could be cost saving 

(Cost ≤0)**

(Range from cost-saving to costly)

P-P-N 

is incrementally costly

$4,563 

Q-P-B vs. 

No vaccination

SoC vs 

No vaccination

P-P-P vs 

No vaccination

P-P-N vs. 

No vaccination

Q-Q vs. 

No vaccination

$/QALY saved* $1,256 $1,461 $1,730 $1,096 $534

$/ LY saved $2,563 $2,908 $3,401 $2,279 $1,254
Probability of Incremental Cost-Effectiveness ratio 

per QALY saved: Q-P-B vs SoC: $/QALY<0 (Pico 1)

32

-8.12 -0.58

5.0% 90.0% 5.0%

0.0

0.2

0.4

0.6

0.8

1.0

-10

-8-6-4-2

0246

Values in Millions ($)

Q-P-B-vs-SoC: Cumulative Probability of ICER per QALY saved* 

*Estimates from Monte Carlo Simulation using a sample of 1000 iterations (Costs were discounted at 3%)

Range are 5th and 95th percentiles 

• Both 5th and 95th

percentiles are 

negative (i.e., cost 

saving)

• More than 95% of the 

iterations were 

negative (i.e., cost 

saving)
Sensitivity of Incremental Cost-Effectiveness ratio per 

QALY saved: P-P-N vs Q-Q $2.9M/QALY gained (Pico 2)

33
34

Strengths and Limitations

Strengths

• Complex modeling 

• Explicit use of incidence and CFR surveillance data for Men BCWY vaccinecontaining serogroups

Limitations

• Data on vaccine effectiveness from pentavalent Men BCWY are from clinical trials

• Hard to ascertain decrease in IMD incidence rates due to natural decline trend vs. 

vaccine induced decline

• Variability of vaccine uptake per type of vaccine
35

Conclusions 

• Disease rates and vaccine cost drive the incremental analyses

• Although additional cases could be prevented by all vaccination 

strategies, they do it at different costs per health outcome

• Most strategies with one or more doses of the Men ABCWY vaccine would 

save more or equal number of cases, but they do at a much higher costs per 

QALY saved when compared to the standard of care.

• The exception is the Q-P-B, which included one dose of Men ABCWY in 

substitution of the second dose of Men ACWY and first dose of Men B.

• Q-P-B could be incrementally cost-saving (ICER QALY <0) relative to the 

standard of care

• Using last 10 years of epidemiology data and current (or proposed) 

vaccine prices increase the cost of all strategies compared to previous 

analyses
End of Presentation
Incidence rate of IMD for serogroups CWY 1996-

2005 and 1996-2020 by age per 100,000

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

=<10 11 12 13 14 15 16 17 18 19 20 21 22 >=23

IMD incidence rate for serogroups CWY per 100,000

Age

Mean CWY 1996-2005

Median CWY 1996-2005

Mean CWY 1996-2020

Median CWY1996-2020

Incidence rates from 1996-2005 for the Pre vaccine Era are from the ABC core surveillance 

Incidence rates from 1996 to 2020 combined data from ABC and NNDSS. 37
Incidence rate of IMD for serogroup B before 

and during vaccine era by age per 100,000

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

11-12 years 13-14 years 15-16 years 17-18 years 19-20 years 21-22 years 23-24 years

IMD incidence rate for serogroup B per 100,000

Age

ABC-1994-2013

2014-2016

2017-2019

2020-2022 Pre

Data from 1994-2013 are from the ABC core surveillance, Data from 2014-2019 are from the NNDSS. 

Data from 2020-2022 also from NNDSS is preliminary 

38
Incidence rate of IMD for serogroups CWY before 

and during vaccine era by age per 100,000

0.01

0.10

1.00

10.00

=<10 11 12 13 14 15 16 17 18 19 20 21 22 >=23

IMD incidence per 100,000(n logarithms)

Age

Mean CWY 1996-2005

Median CWY 1996-2005

Mean CWY 2005-2020

Median CYW 2005-2020

39