Cost-effectiveness analysis of a multicomponent meningococcal serogroup B vaccine in hypothetic epidemic situation in a middle-income country

Figures & data

Table 1. Meningococcal Disease: Direct and indirect costs of acute illness, sequelae and indirect costs of death

A. Acute Illness
a.1 Direct Costs
Service provided	Public Hospital USD $*
- Pre-hospitalization expenses	40
- Hospital bed day	728
- Laboratory tests	136
- Antimicrobial Prophylaxis	17
- Post-dismissal follow-up	153
Total Direct Costs	1,074
a.2 Indirect Costs
- Pre-hospitalization expenses	379
- Hospitalization	727
- Post-hospitalization	505
Total Indirect Costs	1,611
Total Costs of Acute Illness*	2,685
B. Sequelae
b.1 Direct Costs	1,593
b.2 Proportional Indirect Costs	781
Total Costs of Sequelae	2.374
C. Indirect Costs of Mortality	408,086

*The total costs of health services used in each MD cases of the 1993 cohort were calculated (see in Table 2). This costs were applied to the cases detected by surveillance in the following years, 1994 to 1999. Costs are presented at 2013 prices. Annual discount rate 6%.

Table 2. Frequencies and costs of services observed during MD in Public Hospitals, Santiago, Chile (1993)

	Average fee established by the FONASA^# according to MAI& 2013 (USD)	Frequency of services observed during MD in Public Hospitals, Santiago, Chile. 1993
PRE-HOSPITALIZATION EXPENSES
Outpatient visits	8,4	2
Emergency department (ED) visits	22,7	1
- HOSPITAL BED DAY
Intensive Care Unit*	277,7	1,58
Intermediate Treatment Unit *	134,1	0
Basic Care Unit*	66,8	4,33
- LABORATORY TEST
Blood cell count (CBC)	4,5	2
Hematocrit	1	0,42
Platelet count	1,7	0
C reactive protein	6,6	3
Sedimentation rate	0,8	0,58
Blood culture	6,3	2,25
Cerebroespinal fluid cytochemical	4	1,25
Cerebroespinal fluid Gram Stain	1	0,83
Cerebroespinal fluid Latex	6,6	0,75
Cerebroespinal fluid Culture	5,2	0,83
Antibiogram	4,1	3
Pethequial culture	5,2	0,02
Urine culture	5,5	0,25
Stool culture	6,2	0,08
Lactic acid	5,6	0
Plasmatic electrolytes	2,2	4,75
Venous blood gas	5,5	3,33
Creatinine	1,7	0,25
Urean nitrogen	1,2	1,17
Complete urine	2,8	0,42
Glycemia	1,8	1,58
Biochemical profile	12,7	0
Albumin	3,6	0,08
Hepatic tests	15	0,17
Coagulation tests	3,6	0,5
Fibrinogen	6,6	0,08
Plasma osmolality	2,5	0,17
Echocardiogram	100.5	0,17
Electrocardiogram	9	0,08
Abdomen X-ray	10,1	0,08
Thorax X-ray	10,1	0,42
Brain computed axial tomography	136,8	0,08
Blood transfusion	15,9	0
ANTIMICROBIAL PROPHYLAXIS
Ciprofloxacin capsules	0,04	94
Rifampicin suspension	2,29	0,7
Epidemiological visit (contacts)	2,3	2
Contacts education	6,7	1
POST-DISMISSAL FOLLOW-UP
Neurologist visit	10,6	1
Otolaryngologist visit	13,8	1
Evoked potentials	145	0,5
Audiometry	64,5	0,5
Tympanometry	18,5	1
Psychologist visit	5,4	1

^#National Health Fund. ^& Institutional Assistance Regulations. *Include treatment-related expenses.

Table 3. Number, frequencies and proportional costs of MD sequelaes observed in Santiago, Chile during the first epidemic year (1993)

	Number of sequelaes (1993)	Frequencies of sequelaes (%)	Unitary cost of sequelaes	Proportional costs of sequelae (USD)
Intellectual disability (IQ < 80)
- Borderline 79–70	34	36,6	120,6	44,1
- Mild 69 - 55	17	18,3	5872,2	1073,4
- Moderate 54- 4	5	5,4	5872,2	315,7
- Severe 39 -25	0	0	5872,2	0
- Profound	0	0	5872,2	0
Hearing loss
- Mild 20- 40 dB	13	13,9	0	0
- Moderate 40 -70 dB	7	7,5	51,5	3,87
- Severe 70 – 90 dB	2	2,1	492,1	10,6
- Profound ≥ 90 dB	1	1,1	5751,6	61,85
Spastic Paresis
- Mild	2	2,15	549,1	11,8
- Moderated	1	1,1	976,6	10,5
- Severe	0	0	2593	0
Paralysis
- Mild	1	1,08	559,3	6,01
- Moderated	1	1,08	986,9	10,6
- Severe	0	0	2603,4	0
Seizures	4	4,3	604,4	26
Skin grafting	4	4,3	229,7	9,9
Amputation	1	1,08	797,9	8,58
Total of direct sequelaes observed in 1993	93	100		1593

Table 4. Cost of Meningococcal Disease Epidemic Outbreak 1993–1999 Santiago, Chile

Epidemic outbreak years	Year 1 (1993)	Year 2 (1994)	Year 3 (1995)	Year 4 (1996)	Year 5 (1997)	Year 6 (1998)	Year 7 (1999)	Total
N^o Cases #	328	268	328	291	312	294	314	2135
N^o Sequelae #	93	76	93	82	88	83	89
N^o Deaths #	24	20	24	21	23	21	23
Cases Costs* US$	880,680	719,580	880,680	781,335	837,720	789,390	843,090	5,732,475
Sequelae Costs** US$	220,782	180,400	220,782	195,879	210,004	197,897	211,357	1,437,101
Mortality Costs*** US$	9,794,064	8,002,566	9,794,064	8,688,151	9,316,603	8,777,930	9,377,816	63,751,195
Total Costs US$	10,895,526	8,902,547	10,895,526	9,665,365	10,364,327	9,765,216	10,432,264	70,920,771
Present Value Total Costs US$*	10,895,526	$8,398,629	9,696,979	8,115,227	8,209,518	7,297,138	7,354,334	59,967,351
Annual discount ratio of 6%	1	1,06	1,12	1,19	1,26	1,34	1,42

^#Cases, sequelae and death costs are based on data from the MD outbreak in 1993–1999 and presented at 2013 prices.

*Direct cost acute illnes (cases): USD$ 2,685/ **Sequelae cost USD$ 2.374/ ***Mortality cost USD$408,086.

Table 5. MD Outbreak Vaccination Theoretical Model: 4CmenB 3 doses in infants (<12 mo) and one dose given to population between 12 month and 25 y of age in Santiago, Chile

Target Population
Age Group	Total Population	Coverage (%)	Effectiveness (%)	Meningococcal Disease Rates 1993–1999 Outbreak	Unvaccinated Expected Cases/year	Vaccinated Expected Cases/year	Prevented Cases/year
2 mo- 11 mo	82.298	92	80	50,9	42	11	30,8
12 mo – < 2 yrs	102.282	92	80	11,6	12	3,1	8,8
2 yrs– < 5 yrs	303.308	95	92	28,2	85	10,8	74,7
5 yrs- 9 yrs	495.344	95	92	13,6	67	8,5	58,5
10 yrs– 16 yrs	713.133	95	92	5,1	36	4,6	31,6
17 yrs – 19 yrs	340.507	92	92	2,3	8	1,2	6,5
20 yrs– 24 yrs	606.516	92	92	0,8	5	0,8	4,1
Target Population Total	2.643.388		255	40	215
Unvaccinated Population
<2 mo	20.574	0	0	48,6	10	10	0
> 25 yrs	4.240.843	0	0	0,8	34,4	34,4	0
Unvaccinated Population Total	4.261.417		44,4	44,4	0
Total	6.904.805		299,4	84,4	215

Table 6. Effectiveness of 4CmenB vaccination campaign for population under 25 y of age in a hypothetical NmenB MD outbreak in Santiago, Chile

	Unvaccinated expected cases/year	Vaccinated expected cases/year	Prevented cases/year
Cases	299,4	84,4	215
Sequelae	84,7	23,8	60,9
Deaths	21,8	6,1	15,7

Table 7. Costs of the vaccination campaign with hypothetical costs of the vaccine compared to the cost of MD epidemic outbreak

Cost of the vaccine units (USD $)	Vaccination Campaign* (USD $)	Cost of not averted cases, sequelae and death with the vaccine effectiveness estimate^and (USD $)	Net Cost of Vaccination Campaign: Vaccination Campaing plus cost of not adverted cases (USD $)	Cost of MD Epidemic Outbreak plus 1 y of delay^#
0	6.079.449$	6.493.162	12,572,611	69.867.519
5	21.494.878	6.493.162	27,988,040	69.867.519
10	36.938.790	6.493.162	43,431,952	69.867.519
15	52.382.702	6.493.162	58,875,864	69.867.519
20	67.826.614	6.493.162	74,319,776	69.867.519
25	83.270.526	6.493.162	89,763,688	69.867.519
30S	98.493.352	6.493.162	104,986,513	69.867.519
35	114.158.350	6.493.162	120,651,512	69.867.519

*Vaccination campaign: 3 4CmenB doses for infants (2 – 11 months) and one dose for 12 mo to 25 yrs.

^&Calculated based on the observed case rates per age group registered during the first year of the epidemic outbreak (Table 5 and 6).

^#Delay of 12 months from recognition of the outbreak and the start of the vaccination (costs of cases, sequelaes and death of the delay: USD$ 9,900,168).

Figure 1. Sensitivity analysis: Cost of the vaccination campaign to be administered to a population between 2 months to 25 years, at varying vaccines prices.