Should programmes for community-level meningococcal vaccination be considered in Australia? An economic evaluation

Background Disease due to serogroup C Neisseria meningitidis is life-threat ening and potentially preventable by vaccination. In 1999, the UK instigate d mass vaccination after a sustained increase in serogronp C meningococcal disease. Ln the same year, Victoria, Australia experienced a similar change in disease epidemiology. It is timely to undertake an economic evaluation of options for community vaccination in Australia based on local data. Methods Cost-effectiveness and cost-benefit analyses of three options for u se of polysaccharide vaccine were undertaken for a hypothetical population aged 15-19 years. Baseline analyses assumed 5 years' duration of vaccine pr otection following a single year of programme implementation. Sensitivity a nalyses of key variables were performed, including vaccine coverage and eff ectiveness, case fatality rate and the discount rate. Outcomes included the number of people vaccinated, cases averted, life-years saved and disabilit y-adjusted life-years (DALY) averted. Cost-benefit analysis used lost earni ngs avoided as a measure of vaccination benefit. Results Vaccination of people aged 15-19 years in a defined population with a high rate of disease was the most cost-effective option. Compared with n o vaccination and assuming 5 years' duration of protection and exclusion of direct cost savings, this resulted in a discounted cost per life-year save d of $23 623, a cost per DALY avoided of $21 097 and benefits exceeding cos ts in discounted terms. The 'break-even' incidence rate for this option wit h exclusion of direct cost savings was 14.0/100 000. Conclusions Community use of polysaccharide vaccination may be cost effecti ve in Australia under certain conditions. Economic evidence favours use of vaccination in well-defined populations with a high rate of disease. Policy decision-making also requires consideration of non-economic factors, inclu ding feasibility of implementation and risk perception by the community.