• Hong Anh T Tu, Shelley L Deeks, Shaun K Morris, Lisa Strifler, Natasha Crowcroft, Frances B Jamieson, Jeffrey C Kwong, Peter C Coyte, Murray Krahn, and Beate Sander.
• Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6 Toronto, Ontario, Canada. Electronic address: thihonganh.tu@utoronto.ca.
• Vaccine. 2014 Sep 22; 32 (42): 5436-46.

ObjectiveInvasive Neisseria meningitidis serogroup B (MenB) disease is a low incidence but severe infection (mean annual incidence 0.19/100,000/year, case fatality 11%, major long-term sequelae 10%) in Ontario, Canada. This study assesses the cost-effectiveness of a novel MenB vaccine from the Ontario healthcare payer perspective.MethodsA Markov cohort model of invasive MenB disease based on high quality local data and data from the literature was developed. A 4-dose vaccination schedule, 97% coverage, 90% effectiveness, 66% strain coverage, 10-year duration of protection, and vaccine cost of C$75/dose were assumed. A hypothetical Ontario birth cohort (n=150,000) was simulated to estimate expected lifetime health outcomes, quality-adjusted life years (QALYs), and costs, discounted at 5%.ResultsA MenB infant vaccination program is expected to prevent 4.6 invasive MenB disease cases over the lifetime of an Ontario birth cohort, equivalent to 10 QALYs gained. The estimated program cost of C$46.6 million per cohort (including C$318,383 for treatment of vaccine-associated adverse events) were not offset by healthcare cost savings of C$150,522 from preventing MenB cases, resulting in an incremental cost of C$4.76 million per QALY gained. Sensitivity analyses showed the findings to be robust.ConclusionsAn infant MenB vaccination program significantly exceeds commonly used cost-effectiveness thresholds and thus is unlikely to be considered economically attractive in Ontario and comparable jurisdictions.Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

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