Ginita Jutlla

Background In 2025, invasive meningococcal disease (IMD) vaccination in United States (US) adolescents consisted of two standard of care (SoC) schedules: Q-Q-B-B (routine MenACWY [Q] at ages 11 and 16 years; MenB [B] under shared clinical decision-making [SCDM] at age 16 years and 6 months later) or Q-P-B (routine MenACWY at ages 11 and 16 years; MenABCWY [P] at age 16 years and MenB under SCDM 6 months later). We assessed public health impact (PHI) and cost-effectiveness (CE) of intervention strategies on the basis of potential implementation options and revisions to the adolescent meningococcal vaccine schedule proposed in June 2024 by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Methods A model utilizing epidemiological and economic inputs compared projected outcomes for 27 intervention strategies (distinguished by vaccine type [Q, P, and/or B], recommendation type [routine, risk-based], and dosing interval for MenB-containing vaccines [0,6-month , 0,24-month]) versus no vaccination or SoC over 15 years (2025–2039). Discounted outcomes (societal perspective) included IMD cases, deaths, and quality-adjusted life-year losses averted; total direct and indirect costs; and incremental CE ratios. Results Retaining routine MenACWY at age 11−12 years and including routine or risk-based MenB-containing vaccines at age 16 years improved PHI versus SoC, particularly with 0,6-month dosing interval for MenB-containing vaccines. Five strategies incorporating MenABCWY improved PHI and were cost-saving versus SoC: Q-Q-B-B. Conclusions Adolescent meningococcal vaccine schedule revisions retaining routine MenACWY and incorporating risk-based or routine MenABCWY may increase PHI in a cost-effective manner, minimizing the humanistic and economic burden of IMD. Graphical Abstract

Background and Objective Invasive meningococcal disease (IMD) is an uncommon but serious disease associated with a risk of death and severe long-term sequelae, impacting both patients and their caregivers. Productivity losses due to IMD have not previously been comprehensively evaluated in the USA. This study evaluated both market and non-market productivity losses to better estimate the economic burden of IMD in the USA. Methods An economic model estimated lifetime market (labour) and non-market (unpaid household, caring and voluntary services) productivity losses due to acute IMD, premature death due to IMD, reduced life expectancy in IMD survivors and IMD-related sequelae for patients 16 years of age or older and their caregivers based on IMD cases diagnosed in the USA in 2021 (due to data availability). Time use data were used to characterise IMD-incurred disruptions as market or non-market productivity losses. Time lost during the acute phase (assumed equal for patients and caregivers) was estimated based on hospital length-of-stay data. Time lost due to premature death from acute IMD or reduced remaining life expectancy (only calculated for patients) was estimated by subtracting the age at IMD acquisition or life expectancy of IMD survivors from average life expectancy. Time lost due to IMD-related sequelae was estimated based on sequelae event rates. Time lost was multiplied by earnings per hour (derived from median salary) to estimate productivity losses. Assumptions about sequelae impact on productivity were derived from the literature and expert clinical opinion. Scenario and sensitivity analyses assessed the impact of different inputs and assumptions on the results. Costs were inflated to 2023 US dollars. Results Lifetime productivity losses for IMD cases diagnosed in the USA in 2021 (N = 121) totalled $87.4 million ($722,458 per case) for patients 16 years of age and older and their caregivers, with market and non-market losses accounting for approximately 72% and 28%, respectively. Premature death, reduced life expectancy and long-term sequelae were responsible for the majority of total productivity losses for patients and caregivers ($87.1 million); the acute phase accounted for $314,850. Results were most sensitive to the ratio of total benefits, median salary, case-fatality rates and specific sequelae included. Conclusions Despite being an uncommon disease, the high mortality rate and severe long-term consequences of IMD result in a substantial economic impact. Comprehensive market and non-market productivity losses for both patients and caregivers should be considered when evaluating and communicating the true burden of IMD.

Background Invasive meningococcal disease (IMD) is primarily associated with five Neisseria meningitidis serogroups: A, B, C, W, or Y. In the United States (US), available vaccines protect against serogroups B (MenB), A, C, W, and Y (MenACWY), and A, B, C, W, and Y (MenABCWY). The Advisory Committee on Immunization Practices is re-evaluating the adolescent meningococcal vaccination schedule with varying recommendation formats. This analysis aimed to predict which schedule could avert the most IMD cases and have the most positive public health impact (PHI). Methods An epidemiological model compared the 15-year PHI of vaccination schedules using MenB, MenACWY, and/or MenABCWY vaccines versus current US standard of care (SoC). Varying coverage rates reflected routine, shared clinical decision making, and risk-based recommendations. Sensitivity analyses assessed robustness of the results to different inputs/assumptions. Results The most positive PHI compared with SoC was observed with one dose of MenACWY at 11 years of age and two doses of MenABCWY (6 months apart) at 16 years of age, assuming routine recommendation and coverage reflecting real-world uptake of MenACWY. This strategy resulted in 123 IMD cases averted (MenB: 59, MenACWY: 64), 17 deaths prevented, 574 life-years saved, and 757 quality-adjusted life-years gained versus SoC. Eliminating MenACWY vaccination at 11 years was found to result in an additional IMD burden. Conclusion A routinely recommended two-dose pentavalent vaccine, with doses administered 6 months apart at 16 years of age, alongside the routinely recommended MenACWY vaccine at 11 years of age, would improve the PHI and benefits of IMD vaccination to society. Graphical Abstract