Cost-Benefit Model Comparing Two Alternative Immunisation Programmes Against Serogroup C Meningococcal Disease

Objective: To evaluate the most efficient approach to managing an outbreak of serogroup C meningococcal disease. An early planned mass immunisation programme (MIP) was compared with a delayed programme implemented at the peak of a meningococcal outbreak. Design and setting: A cost-benefit model was constructed of meningococcal cases reported in Quebec, Canada, from 1990–1993, before and after the MIP, during the winter of 1992–1993, when 84% of residents aged 6 months to 20 years were vaccinated. Epidemiological data from 1990–1993 were transposed to 2002–2003 under the assumption that Quebec is on the brink of an identical outbreak cycle. All Quebec residents aged 2 months to 20 years were assumed to be vaccinated, which required a total of 1.7 million doses of conjugated vaccine. Clinical and economic outcomes of both vaccination scenarios were compared. All costs were transformed to 2001 Canadian dollars ($Can), at an annual inflation rate of 3%. Future earnings due to premature death were discounted at 5% per year with a 3% increase in wages per year and a 9% unemployment rate. Perspective: Ministry of Health and society. Main outcome measures: The number of new cases avoided and the prevention of hospital and societal costs due to meningococcal disease-attributed premature mortality and morbidity, and direct costs associated with implementation of a MIP. Results: When compared with a delayed MIP over a 14-month period, an early planned MIP would have prevented 112 new cases of meningococcal disease (16 deaths, 21 major complications) while saving $Can37.1 million in total direct costs to the Ministry of Health and an additional $Can17.4 million in societal costs in the province of Quebec. Conclusion: An early planned MIP implemented in Quebec in September 2001, should be cost beneficial compared with delaying mass immunisation until a meningococcal outbreak is underway. Although this conclusion is limited by the assumption that epidemiological trends in 2001 in absence of a MIP would have been similar to that observed in the early 1990s prior to the MIP, the analysis still indicates that an early MIP in the 1990s would have been cost beneficial compared with a delayed MIP.