Langevin E, Robertson C, Galarza K, Dogu A, Cristeau O, Clay E, Wu J, Shin T
Sanofi Vaccines, Lyon, France.
Sanofi Vaccines, Swiftwater, PA, USA.
BMC Public Health. 2025 May 20;25(1):1863. doi: 10.1186/s12889-025-21953-8.
A two-dose series of quadrivalent meningococcal conjugate vaccine (MenACWY) is recommended for the prevention of invasive meningococcal disease (IMD) in adolescents in the United States. In June 2024, the Advisory Committee on Immunization Practices discussed plans to review the adolescent meningococcal vaccination schedule. Various options are under consideration, including removing the first dose of MenACWY at age 11-12 years.
We evaluated the public health impact and cost-effectiveness of administering one or two doses of MenACWY compared to a scenario with no vaccination.
We constructed an incidence-based population model to compare costs and quality-adjusted life years (QALYs) associated with different vaccination schedules in a cohort of 11-25 year-olds, from a societal perspective, over a lifetime analytic horizon for outcomes related to death and disabilities. The main analyses compared various scenarios of MenACWY (Q) and MenB schedules to no vaccination. Further scenarios examined the impact of alternative assumptions applied to the first and/or second dose of MenACWY.
Compared to no vaccination, 2 doses of MenACWY and 2 doses of MenB vaccine was projected to reduce IMD cases by 277 per year, resulting in an incremental cost-effectiveness ratio (ICER) of $625,322/QALY. Administering 2 doses of MenACWY was projected to reduce the annual number of IMD cases by 275 at an ICER of $438,948/QALY, which increased to 631 at an ICER of $190,030/QALY when herd immunity was considered. Alternatively, if only 1 dose of MenACWY was administered, the reduction in cases would be 253 if administered at 11-12 years old and 125 if given at 16 years, with ICERs of $252,249 per QALY and $352,169/QALY, respectively. Assuming a 25% increase in vaccination coverage rate, one MenACWY dose at 16 years resulted in 156 cases avoided.
The two doses of MenACWY that are currently recommended play a crucial role in reducing the burden of IMD and the first dose contributes significantly (≥ 90%) to this reduction. It is essential to take this finding into account when considering any updates to the adolescent meningococcal vaccination schedule in the United States.
在美国，推荐接种两剂次的四价脑膜炎球菌结合疫苗（MenACWY）以预防青少年侵袭性脑膜炎球菌病（IMD）。2024年6月，免疫实践咨询委员会讨论了审查青少年脑膜炎球菌疫苗接种计划的方案。正在考虑各种选项，包括取消11至12岁时的第一剂MenACWY疫苗接种。
我们评估了与不接种疫苗的情况相比，接种一剂或两剂MenACWY的公共卫生影响和成本效益。
我们构建了一个基于发病率的人群模型，从社会角度比较在11至25岁队列中不同疫苗接种计划在终身分析期内与死亡和残疾相关结果的成本和质量调整生命年（QALY）。主要分析将MenACWY（Q）和MenB疫苗接种计划的各种情况与不接种疫苗进行比较。进一步的情况研究了应用于MenACWY第一剂和/或第二剂的替代假设的影响。
与不接种疫苗相比，预计接种2剂MenACWY和2剂MenB疫苗每年可减少277例IMD病例，增量成本效益比（ICER）为每QALY 625,322美元。预计接种2剂MenACWY每年可减少275例IMD病例，ICER为每QALY 438,948美元，考虑群体免疫时，该数字增加到631例，ICER为每QALY 190,030美元。另外，如果只接种1剂MenACWY，11至12岁接种时病例减少253例，16岁接种时减少125例，ICER分别为每QALY 252,249美元和每QALY 352,169美元。假设疫苗接种覆盖率提高25%，16岁接种1剂MenACWY可避免156例病例。
目前推荐的两剂MenACWY在减轻IMD负担方面发挥着关键作用，第一剂对此减轻负担的贡献显著（≥90%）。在美国考虑对青少年脑膜炎球菌疫苗接种计划进行任何更新时，必须考虑到这一发现。
