OBJECTIVES: In the past few decades, cost-effectiveness analyses (CEA) of vaccination programs have been part of the decision-making process. However, results of a standard CEA may be less favorable for vaccines that provide protection against rare diseases with potentially catastrophic outcomes. An example are vaccines to protect against Invasive Meningococcal Disease (IMD). In order to understand the impact of IMD incidence, CEA and disease characteristics on policy decisions about IMD vaccination programs, we describe the evolution over time and the factors driving this evolution in four countries: the UK, US, the Netherlands, and Canada.
METHODS: A targeted literature review was conducted of publications and internet sources for the four countries relating to IMD vaccination. The review focused on the impact of CEA results on vaccine policy decisions and how other factors influenced policy decisions.
RESULTS: Three types of meningococcal vaccines are available to protect against serogroup(s) B, C or ACWY. The Figure 1 illustrates the evolutions of the recommendation in relation to epidemiology in 4 countries. The review indicated that the recommendations have considered CEA results and these have impacted the specific age groups targeted. However, when outbreaks of IMD occurred, pressure from parents, physicians, and the media and support from public health authorities have also influenced the recommendations. In addition, vaccine availability, changes in the incidence of different IMD serogroups over time, and the catastrophic nature of the disease that is exacerbated by the difficulty in achieving early diagnosis and by its rapid development have been considered in the decision-making process.
CONCLUSIONS: IMD vaccination programs in four countries with formal processes for their evaluation were based on IMD incidence, the frequently catastrophic nature of the disease and CEA results.
