A cost-effectiveness analysis of vaccination strategies against N-meningitidis meningitis in sub-Saharan African countries

This analysis evaluates the cost-effectiveness (C/E) of routine vaccination against Neisseria meningitidis. Three different preventive strategies are analyzed: mass vaccination during epidemics (the current standard of care), routine preventive vaccination and a combination strategy of routine vacci nation with mass vaccination during epidemics. A Markov model is used to si mulate the epidemics of meningitis in a cohort of 5-year old children and c ompare these different strategies. The results show that mass vaccination s trategy is dominated by the two other strategies. The incremental C/E ratio s are US$50/QALY for the routine vaccination, and US$199/QALY for the combi nation strategy. The costs per fatal case averted are US$1161 for the routi ne vaccination, and US%2397 for the combination strategy. The C/E ratios ar e sensitive to: the incidence of meningococcal meningitis, the costs of tre ating cases, the costs of routine vaccination and the costs and effectivene ss of mass immunization campaign. However the rank ordering of the strategi es is almost never altered. In conclusion, the results of this analysis sug gest that mass vaccination in sub-Saharan Africa in case of epidemics Shoul d be reconsidered. Routine vaccination against meningococcal meningitis at an early age, with or without mass vaccination during epidemics is more eff ective, with a C/E ratio within the range of other vaccination strategies c urrently in place in Africa. (C) 1999 Elsevier Science Ltd. All rights rese rved.