Cost-Effectiveness of Meningococcal Quadrivalent Conjugate ...

3 downloads 92 Views 313KB Size Report
In September 2012, the New York City (NYC) Department of Health and Mental Hygiene ... IMD cases, IMD deaths, quality adjusted life years (QALYs), costs.
Cost-Effectiveness of Meningococcal Quadrivalent Conjugate Vaccination Campaign among Men Who Have Sex With Men in New York City Matthew S. Simon1*, Don Weiss2, Anita Geevarughese2, Molly Kratz2, Blayne Cutler3, Roy M. Gulick1, Jane R. Zucker2, Jay K. Varma2, Bruce R. Schackman1 1

Weill Cornell Medical College, New York, NY; 2 New York City Department of Health and Mental Hygiene; 3Public Health Foundation Enterprises *Corresponding author. email: [email protected]

500,000 Monthly cases predicted with herd immunity

Vaccination campaign initiated

No vaccination

Monthly cases predicted without herd immunity Number of cases observed

2

Vaccination

Difference

Difference range

no herd immunity

450,000 herd immunity

IMD cases

400,000

Herd immunity

9.6

No herd immunity

IMD cases

6.9

8.6

2.7

8.5

0.9-.60

1.1

1

0.5-2.1

Herd immunity

3.7

2.7

1.0

0.2-2.5

$/QALY 250,000

No herd immunity

3.7

3.3

0.4

0.1-0.9

200,000

Strategy

No vaccination

KEY MODEL INPUTS

METHODS

Variable IMD Incidence in NYC MSM (per 100,000) HIV positive HIV negative

0 1

66,000

7.6

4.0-24.0

No herd immunity

2,345,400

1,551,600

1,096,099

9

177,000

20.1

13.0-25.0

75-95%

17%

10-40%

20%

0-63%

IMD mortality HIV positive

42%

10-60%

HIV negative

20%

5-40%

34%

5-75%

Vaccination (variable and fixed costs) Herd immunity

2,789,200

1,995,400

1,096,112

22

93,000

No herd immunity

2,922,400

2,128,600

1,096,099

9

243,000

ICER ($/QALY) 0

$55,600 $53,800 $120 $577,000

+/- 50% +/- 50%

IMD case fatality ratio

+/- 50%

IMD incidence

+/- 50%

Vaccine cost

50,000

100,000

150,000

200,000

0.83-0.88 0.89-0.95

0.70

0.5-0.8

Vaccine effectiveness

Proportion of HIV in target population

5

7

9

11

13

15

17

19

LIMITATIONS • Actual impact of herd immunity, if any, is unknown • Herd immunity not evident since introduction of meningococcal quadrivalent conjugate (MCV4) vaccination in US adolescent population4 • Herd immunity and critical vaccination threshold assumptions based on modeling data from United Kingdom5 • IMD transmission dynamics within MSM communities are poorly understood. • MCV4 effectiveness in HIV-infected adults based on limited data in HIV-infected adolescents6 • Unable to characterize effect of fixed costs on vaccination rates • Did not evaluate cost-effectiveness of routine vaccination of high-risk MSM with or without HIV

CONCLUSIONS • Targeted vaccination of NYC MSM in the context of an IMD outbreak may have averted IMD cases and deaths • Vaccination was cost-effective at a $100,000/QALY threshold but depended on: • Herd immunity • IMD incidence > 12 per 100,000 • Case fatality >18% • At a cost-effectiveness threshold consistent with adolescent meningococcal program ($220,000/QALY)4, vaccination was cost-effective even without herd immunity, but was sensitive to the inclusion of fixed costs.

ACKNOWLEDGEMENTS • Marcelle Layton, Sarah Braunstein, Colin Shepard ,NYC Department of Health and Mental Hygiene • Ankur Pandya and Jared Leff, Weill Cornell Medical College

Probability of long-term neurological disability

0.86 0.92

3

Incidence (IMD cases per 100,000 persons)

Tornado analysis depicting results of 1-way sensitivity analysis of key variables (variable costs only)

Herd immunity

costs8

Vaccine costs (includes labor/administration fee) Fixed costs of DOHMH vaccination program (labor, media, community outreach) Baseline QALY weight HIV positive9 HIV negative10 QALY weight long-term IMD disability10

-----

22

90%

Long-term disability

50,000

1,096,112

HIV negative7

Acute

1,096,090

ICER ($/QALY)

1,418,400

25-95%

IMD treatment

----

793,800

Incremental QALYs

2,212,000

62%

IMD long-term disability8

Total QALYs

Herd immunity

HIV positive6

Herd immunity risk reduction in unvaccinated MSM

Incremental cost

Vaccination (variable costs only)

Vaccine effectiveness

Vaccine coverage

Cost

Range

Base case

$100,000/QALY threshold

150,000 100,000

Sep-13

Aug-13

Jul-13

Jun-13

May-13

Apr-13

Mar-13

Feb-13

Jan-13

Dec-12

Nov-12

Oct-12

Sep-12

Aug-12

Jul-12

Jun-12

May-12

Apr-12

Mar-12

• To estimate the cost-effectiveness of meningococcal vaccination among HIV-infected and HIV-uninfected MSM based on the NYC experience.

Base case incidence

$220,000/QALY threshold

300,000

Projected cost-effectiveness of meningococcal vaccination in 60,000 NYC MSM 0

ACIP recommendation to vaccinate

350,000

IMD deaths

STUDY OBJECTIVE

• Decision analytic model • Simulated cohort • 60,000 NYC MSM (estimated size of target population) • Mean age 35 years • HIV positive 65% (87% CD4>200 and 13% CD4