Economics of Potential Pentavalent Meni

Conjugate Vaccine (MenABCWY) versus th

MenACWY and MenB vaccines for US Ad

A SUMMARY REPORT COMPARING MODELS FROM:

Pfizer AND CDC

Ismael R. Ortega-Sanchez, PhD

NCIRD/CDC

Meningococcal ACIP Meeting, October 25, 2023 

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

the Centers for Disease Control and Prevention. 

National Center for Immunization & Respiratory Diseases
Conflict of interest

• Pfizer model: Shannon Sullivan et al., [complete authors l

affiliations, upon request ]

• Pfizer manufactures pentavalent (MenABCWY) vaccine• Evidera Inc. (France, USA, Hungary) was funded by Pfiz

• CDC model: Ismael R Ortega-Sanchez et al. from CDC [co

authors list and affiliations, upon request ]

• All authors: No conflicts of interest
3 Policy questions for economic model

• Should the pentavalent vaccine (MenABCWY) be consider

option for MenACWY/MenB vaccination in people currentrecommended to receive both vaccines? (PICO 1)

• Should the pentavalent vaccine (MenABCWY) be included 

option for people currently recommended to receive Men

(PICO 2)

• Should the pentavalent vaccine (MenABCWY) be included 

option for people currently recommended to receive Men

(PICO 3)
Economic analysis

Question: Is vaccinating adolescents 11-16 years old with Pentavalent (Mvaccine series to prevent Invasive Meningococcal Disease in adolescents 

Comparator Interventions

Base-case scenario: What is the incremental cost-effectiveness of vaccinatinadolescents 11-12 and 16 years old with Pentavalent vaccine relative to usin

and MenB vaccines ?

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 Pen

MenABCWY 

combined e

Q-P

P-P

or Q-P
Description of Current and Hypothetica

Vaccines and Vaccination Strategies 

Standard of Care (SoC) Potential vaccination strategies

First dose Second dose Key Label First dose Second dose Third 

At 11-12 yrs

old with 

MenACWY

At 16 yrs old

with MenACWY Q-Q

At 11-12 yrs old 

with MenACWY

At 16 yrs old with

MenABCWY

At 16.5 yrs 

Me

At 11-12 yrs old 

with MenABCWY

At 16 yrs old with 

MenABCWY None 

At 16 yrs old 

with MenB

At 16.5 yrs old

with MenB B-B At 11-12 yrs old with MenACWY At 16 yrs old with MenABCWY At 16.5 yrs 

MenAB

SoC= Standard of care (current vaccination programs: 

Q-Q and 

B-B)

MenABCWY = Potential pentavalent vaccine (

P) with serogroups A, B, C W Y

MenACWY = currently recommended quadrivalent vaccine (

Q) for serogroups A, C, W, Y,

MenB =currently recommended monovalent vaccine for serogroup 

B 
Pfizer and CDC: incremental cost- : incremental cost-effectiven

effectiven

analyses of vaccination strategies with pen

Policy 

question

Incremental 

analysis

Pfizer CDC 

PICO #1 Q-P-B vs SoC Included* Included 

PICO #2 P-P-N vs Q-Q Included Included 

PICO #3 Q-P-P vs SoC Included Included 

SoC = Standard of care (current vaccination programs: Q-Q and B-B)

* Included in Pfizer technical report updates until August 2023, not included in the Pfizer technical report update of Oct

** The price of $250 (private) / $187.5 (public) is for strategies using a single dose of pentavalent and the price of $21

(public) for strategies using ≥2 doses of pentavalent 
Focus on key features for model compa

• Modeling approach

• Targeted population(s)• Perspective (healthcare vs. societal)• Intervention strategies and comparators

• Inputs for IMD burden, vaccine efficacy, and costs

• Incidence of IMD rates and sequelae outcomes• Direct and indirect costs of IMD• Intervention: efficacy, duration of protection, safety and progra

• Assumptions

• Strong, influential assumptions
Modeling design and assumptions

Pfizer 

Static analytical decision-making models ✔ Sensitivity analyses (and probabilistic simulation)

✔(✔) 

Hypothetical population: US cohort of adolescents ≥11 years of age ✔ Time Frame: 15 years (from 11-25 years) ✔ Analytic Horizon: Temporary disability (acute without sequelae) and Life Expectancy (permanent sequalae or premature mortality)

✔

✔

Discount rate: 3% ✔ Year of health and economic outcomes measured: 2022 ✔ Societal perspective (and healthcare perspective)

✔(✔) 
Inputs and main outcomes

Prevention of:• IMD cases• IMD-associated sequelae• IMD-associated deathsQALYs saved$/QALY savedNumber needed tovaccinate (NNV) to avert an:• IMD case• IMD death

P

IMD = invasive meningococcal diseaseHCRU = healthcare resource utilization QALY= quality-adjusted life year
Pfizer and CDC models comparison: 

Selected inputs 

• Cost of vaccine and vaccine administration• IMD incidence for pre vaccine and vaccine era• Initial vaccine effectiveness and waning over time• IMD associated permanent sequalae • Age and serogroup specific Case Fatality Rate (CFR)• Acute IMD: QALY scores and unitary direct costs

IMD = Invasive meningococcal diseaseQALY= Quality-adjusted life years 

Note: Starting this slide and forward, to specifically identify changes and updates from those presented l

text will appear either highlighted, or with the word updated at the top of the slide or table. 
Pfizer vaccine price for a dose of Penta

Vaccination 

Strategies

March to June 

2023*

August 2023** Octobe

With one dose

Private $240 

($230-$250)

$250.0 $2

Public -- 187.5 18

With ≥ 2 doses 

Private $240 

($230-$250)

$250.0 $2

Public -- 187.5 $1

* From March to June 2023, Pfizer submitted various technical reports using the pentavalent vaccine prices of $240 (range $230 to $250) p** In August 2023, Pfizer submitted a new technical report updating the pentavalent prices to $250 (private) / $187.5 (public) per dose

*** In October 2023, Pfizer submitted a newer technical report updating the pentavalent prices to $210 (private) / $157.5 (public) per dose 

of pentavalent 
Pfizer and CDC: Vaccine cost per vaccine 

and vaccine administration costs

* 2023 public and private sector cost per dose; VFC Current CDC Vaccine Price List, CDC.**2023 Proportions of vaccine purchased at private sector and procurement from either private or private providers were based on different sources (i

https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202305_1.pdf, Glazner et al., Pediatrics 2009)*** Calculated using a hypothetical range of prices for public and private as reported by Pfizer Inc. for MenABCWY .¶ Assumption considers wastage from either open vial, mishandling or outdated shelf life. Note: CDC model: rates and associated costs of hypothetical vaccine associated adverse events, non shown here, were applied to all vaccines.

Trotter et al., BMJ 2002 https://pubmed.ncbi.nlm.nih.gov/11934772/ ; Ortega-Sanchez et al., CID 2008. https://pubmed.ncbi.nlm.nih.gov/18171206/

Quadrivalent (Q)* Men B (B)*

Pe

Q-P-B

(single do

public sector cost for vaccine $105.6 $141.84 $187.5 

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

Pfizer: weighted cost per dose + administration $155.61 $ 200.67 $243.11*% vaccine waste¶ 4.5% 4.5% 4.5% CDC: weighted cost per dose + administration $162.61 ($128 - $191) $ 209.70 ($155 - $250) $254.05*

($205 - $2
Pfizer and CDC: Average Annual Incidence in Vaccine 

Serogroups BCYW by Age per 100,000 used in the mo

Source: CDC Model: Age-by-year-specific data from ABC Core Surveillance and NNDSS for PreVaxs and Vax eras

Pfizer model: Pre Vax Era: Mbaeyi et al. Incidence of Meningococcal Disease Before and After Implementation of Quadrivalent Meningococc

the United States. JAMA Pediatr. 2020;174(9):843-851. doi:10.1001/jamapediatrics.2020Vax Era: US CDC Enhanced Meningococcal Disease Surveillance Report, 2017. Enhanced Meningococcal Disease Surveillance Report, 2017 (c

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

• • 
Pfizer and CDC: Initial vaccine effective

: Initial vaccine effective

Initial vaccine effective

vaccine and serogroup

QUADRIVALENT MEN B 

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

First DOSE MenACWY 93% 73% 98% 93% 

2nd + DOSE MenACWY 97% 73% 98% 97% First DOSE MenB* 60% 18% 74% 60% 2nd + DOSE MenB 85% 50% 99% 85% 

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 

Updated Pfizer Technical reports on Cost-effectiveness of the Pentavalent Meningococcal Vaccine (MenABCWY) in the US 

Cohn AC, MacNeil JR, Harrison LH, et al. Active Bacterial Core Surveillance (ABCs) Team and MeningNet Surveillance Partners. EffectivenesOne Dose of a Meningococcal Conjugate Vaccine. Pediatrics. 2017 Feb;139(2):e20162193. doi: 10.1542/peds.2016-2193. PMID: 28100689*The range for VE efficacy for first dose of MenB is from Castilla et al. NEJM 2023 https://www.nejm.org/doi/full/10.1056/nejmoa220643
Pfizer CDC

Pfizer and CDC: Assumption about residu

protection by vaccine and serogroup

Assumptions on residual protection are based on various sources:• Sero-protection is assumed to persist 4-5 years for a single dose of MenACWY and MenABCWY (based on hSBA sero bactericidal assay from Pfizer’s c

• Pfizer Technical report on Cost-effectiveness of the Pentavalent Meningococcal Vaccine (MenABCWY) in the US.

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

CYW

BB

CYW

CYWB
Pfizer CDC

Pfizer and CDC: Long-term sequalae and C

term sequalae and C

included in the models

* Range is a +/- 20% of base-case** In addition to CFR, it is assumed an increased risk of excess mortality of 1.21 (1.06-1.37); i.e., reduced life expectancy among survivors with sequalae

Long-term sequelae PrSkin scarring Single amputation Multiple amputations Hearing loss Significant long term neurologic disability

28.5% (24.2 - 34.3)* 

Case Fatality Rate (CFR) For serogroups BCWY Case Fatality Rate (CFR) FCFR in 11-25 years ** 12.5% (10 to <15yrs)

8% (15 to <25yrs)

CFR in 11-25 years*** 

*** Weighted average by age and serogroup proporange is from serogroup B, high value is from serogSA=Sensitivity analysis
Pfizer and CDC: Direct costs and QALY s

used in modeling acute phase of IMD

CDC Pfize

Direct cost: Medical unitary costsPublic health response

Medical cost for an IMD acute phase 

only $48,983 a

Public response per isolated case 

$13,547 

Medical cost of IMD acu

Meningitis 

Septicemia 

Unspecified 

IMD cases without permanent sequelae during acute phase

Disutility: 0.12 for a year b

Equivalent QALDs: 46.24 days 

Disutility: 0.4 to 0

Equivalent QALDs: 

IMD cases without permanent sequelae after acute phase 

Disutility: 0.083 for a year c

Equivalent QALDs: 14.8 days 

Disutility: 0.03 (ra

Duration: 

Equivalent QAL

a. Medical costs were adjusted to 2022 using the GDP implicit deflator index. Public response costs were based per hour wage of public 

per case, cost of chemoprophylaxis, average number of contacts per case.

b. QALD = quality-adjusted life days lostc. Assumption after acute phase based on 2/3 of disutility during acute phase for patients without permanent sequelae

d. Unitary cost per type of IMD based on Davis et al https://pubmed.ncbi.nlm.nih.gov/21278486/

e. Derived from Lecocq et al. Vaccine 2016 https://pubmed.ncbi.nlm.nih.gov/27002504/f. Koomen et al. Qual Life Res. 2005 https://pubmed.ncbi.nlm.nih.gov/16110936/ and Schmand et al J Infect. 2010 https://pubmed.nc
*Updated from Monte Carlo Simulation using a sample of 1000 iterations. Preliminary estimates. ICER = Increment

** Both total net costs estimates relied on $250 (private)/$187.5 (public) cost per dose of pentavalent vaccine

-10.54 -1.21

5.0% 90.0% 

0.00.20.40.60.81.0

-20

-15

-10

-50

Values in Mil

CDC: Cumulative probability of ICER per 

Policy question 1: Pfizer and CDC*: Penta

vaccine price $250 vaccine price $250 (private)/ (private)/ (private)/$187.5 (public)** (public)** 

Pfizer

Q-P-B vs SoC

CDC

Q-P-B vs SoC

IMD cases saved 0 <0 – 5

IMD deaths saved 0 0 – 3LY saved 0 <0 – 28

QALYs saved 0 <0 – 42Total Net Costs (millions)

($426)** ($564)**

$/QALY saved Cost savings

($/QALY <0)

Cost savings

($/QALY <0)

What is the incremental effectiveness and cost-effectiveness of vaccinating healthy adolesce

years old with Pentavalent vaccine relative to using MenACWY and MenB vaccines ?
Policy question 2: Pfizer: Pentavalent vaccin

Pentavalent vaccin

$210 (private)/$157.5 (public)* $210 (private)/$157.5 (public)* 

P-P-N vs Q-Q

IMD cases saved 41IMD deaths saved 4LY saved 86QALYs saved 164Total Net Costs (millions)

$319

$/QALY saved $1.94 Million

What is the incremental effectiveness and cost-effectiveness of vaccinating healthy adolesce

years old with Pentavalent vaccine relative to using MenACWY only?

ICER = incremental cost-effectiveLTS = Long-term sequelae * Updated Pfizer estimates with pentavalent vaccine price $210 (private)/ $157.5 (Public) and 

tornado figure
1.73 9.15

5.0% 90.2% 

0.00.20.40.60.81.0

0369

Values in Millions ($)

CDC: Cumulative probability of ICER per QALY 

Policy question 2: CDC*: Pentavalent vaccine 

$210 (private)/$157.5 (public) ** $210 (private)/$157.5 (public) **

P-P-N vs Q-Q

IMD cases saved 12

IMD deaths saved 1LY saved 27QALYs saved 58Total Net Costs (millions)

$270

$/QALY saved $4.7 Million

What is the incremental effectiveness and cost-effectiveness of vaccinating healthy adolesce

years old with Pentavalent vaccine relative to using MenACWY only?

Baseline: $

*Updated from Monte Carlo Simulation using a sample of 1000 iterations. Preliminary estimates** Updated Pfizer estimates with pentavalent vaccine price $210 (private)/ $157.5 (Public) ICER = Incremental cost-eff
Policy question 3: Pfizer and CDC: Pentav

vaccine price $210 (private)/$157.5 (public)* 

What is the incremental effectiveness and cost-effectiveness of vaccinating healthy adolesce

with Pentavalent vaccine relative to using MenB vaccine only ?

Pfizer

Q-P-P vs SoC

CDC**

Q-P-P vs SoC

IMD cases saved

4 5

IMD deaths saved

0 0 - 2

LY saved 9 26

QALYs saved 17 39Total Net Costs (millions)

($528) ($639)

$/QALY saved Cost savings

($/QALY <0)

Cost savings

($/QALY <0)

* Updated Pfizer estimates using $210 (private)/$157.5 (public) cost per dose of pentavalent vaccine** Updated from Monte Carlo Simulation using a sample of 1000 iterations. Preliminary estimates ICER = Incremental cost-e

-15.95 -0.58

5.0% 90.0% 

0.00.20.40.60.81.0

-20

-15

-10

-50

Values in Millio

CDC: Cumulative probability of ICER per Q
Limitations

• Factors not considered in Pfizer and CDC models that may result in overestimat

(underestimating the cost-effectiveness) of MenABCWY

• In base-case: both models assumed

• No protection against non-IMD• No indirect protection against IMD of unvaccinated individuals

• Productivity losses incurred by caregivers for long-term specific sequelae are 

assumptions and partially included

• Differences in key inputs among Pfizer and CDC models and the uncertainty in inputs da

some differences in results:

• Duration of vaccine protection• Medical costs• Variability in IMD incidence and CFR data• Inclusion of different sequalae• QALY score for IMD cases without permanent sequelae

• Pentavalent price for Q-P-B is uncertain: price used here is the minimum expected. High

increase total net cost & ICERs 
Conclusion

• In both Pfizer and CDC models, MenABCWY vaccine would reduce the IMD burde

• In both models, strategies with one or more doses of the MenABCWY vaccine would s

number of IMD cases.

• PICO #1: Q-P-B could be incrementally cost-saving (ICER QALY saved <0) relative 

• Q-P-B includes one dose of MenABCWY in substitution of the second dose of MenAC

of MenB

• PICO #2: P-P-N is incrementally costly (not cost saving) relative to Q-Q.

• P-P-N included two doses of MenABCWY in substitution of the two doses of MenACW

• PICO #3: Q-P-P is likely cost saving (ICER QALY saved <0) relative to SoC

• About 96% percent of iterations in the CDC model simulations have an ICER<0

• Q-P-P included two doses of MenABCWY in substitution of the second dose of MenAC

and second dose of MenB

• Reasonable pentavalent price and duration of protection combined with careful d

vaccination interventions with MenABCWY would determine the cost or cost-savi

pentavalent vaccine among adolescents ≥11 year of age 
Acknowledgements 

From NCIRD/CDC• Lucy Alexandra McNamara• Jennifer Collins• Andrew LeidnerAlso:• ACIP Meningococcal working group members
End of Summary