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      Economic evaluation of meningococcal vaccines: considerations for the future

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          Abstract

          In 2018, a panel of health economics and meningococcal disease experts convened to review methodologies, frameworks, and decision-making processes for economic evaluations of vaccines, with a focus on evaluation of vaccines targeting invasive meningococcal disease (IMD). The panel discussed vaccine evaluation methods across countries; IMD prevention benefits that are well quantified using current methods, not well quantified, or missing in current cost-effectiveness methodologies; and development of recommendations for future evaluation methods. Consensus was reached on a number of points and further consideration was deemed necessary for some topics. Experts agreed that the unpredictability of IMD complicates an accurate evaluation of meningococcal vaccine benefits and that vaccine cost-effectiveness evaluations should encompass indirect benefits, both for meningococcal vaccines and vaccines in general. In addition, the panel agreed that transparency in the vaccine decision-making process is beneficial and should be implemented when possible. Further discussion is required to ascertain: how enhancing consistency of frameworks for evaluating outcomes of vaccine introduction can be improved; reviews of existing tools used to capture quality of life; how indirect costs are considered within models; and whether and how the weighting of quality-adjusted life-years (QALY), application of QALY adjustment factors, or use of altered cost-effectiveness thresholds should be used in the economic evaluation of vaccines.

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          Most cited references31

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          Epidemic meningitis, meningococcaemia, and Neisseria meningitidis.

          Meningococcus, an obligate human bacterial pathogen, remains a worldwide and devastating cause of epidemic meningitis and sepsis. However, advances have been made in our understanding of meningococcal biology and pathogenesis, global epidemiology, transmission and carriage, host susceptibility, pathophysiology, and clinical presentations. Approaches to diagnosis, treatment, and chemoprophylaxis are now in use on the basis of these advances. Importantly, the next generation of meningococcal conjugate vaccines for serogroups A, C, Y, W-135, and broadly effective serogroup B vaccines are on the horizon, which could eliminate the organism as a major threat to human health in industrialised countries in the next decade. The crucial challenge will be effective introduction of new meningococcal vaccines into developing countries, especially in sub-Saharan Africa, where they are urgently needed.
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            Meningococcal disease.

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              Clinical recognition of meningococcal disease in children and adolescents.

              Meningococcal disease is a rapidly progressive childhood infection of global importance. To our knowledge, no systematic quantitative research exists into the occurrence of symptoms before admission to hospital. Data were obtained from questionnaires answered by parents and from primary-care records for the course of illness before admission to hospital in 448 children (103 fatal, 345 non-fatal), aged 16 years or younger, with meningococcal disease. In 373 cases, diagnosis was confirmed with microbiological techniques. The rest of the children were included because they had a purpuric rash, and either meningitis or evidence of septicaemic shock. Results were standardised to UK case-fatality rates. The time-window for clinical diagnosis was narrow. Most children had only non-specific symptoms in the first 4-6 h, but were close to death by 24 h. Only 165 (51%) children were sent to hospital after the first consultation. The classic features of haemorrhagic rash, meningism, and impaired consciousness developed late (median onset 13-22 h). By contrast, 72% of children had early symptoms of sepsis (leg pains, cold hands and feet, abnormal skin colour) that first developed at a median time of 8 h, much earlier than the median time to hospital admission of 19 h. Classic clinical features of meningococcal disease appear late in the illness. Recognising early symptoms of sepsis could increase the proportion of children identified by primary-care clinicians and shorten the time to hospital admission. The framework within which meningococcal disease is diagnosed should be changed to emphasise identification of these early symptoms by parents and clinicians.
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                Author and article information

                Contributors
                Hannah.Christensen@bristol.ac.uk
                vinnys@meningitis.org
                Journal
                Eur J Health Econ
                Eur J Health Econ
                The European Journal of Health Economics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1618-7598
                1618-7601
                21 November 2019
                21 November 2019
                2020
                : 21
                : 2
                : 297-309
                Affiliations
                [1 ]GRID grid.5337.2, ISNI 0000 0004 1936 7603, Population Health Sciences, Bristol Medical School, , University of Bristol, ; Bristol, BS8 2BN UK
                [2 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, Health Economics Unit, , University of Birmingham, ; Birmingham, B15 2TT UK
                [3 ]GRID grid.11024.36, ISNI 0000000120977052, Université Paris-Dauphine, PSL Research University, LEDa [LEGOS], ; 75775 Paris, France
                [4 ]Department of Pharmacy, University Medical Center/University of Groningen, 9712 CP Groningen, The Netherlands
                [5 ]Department of Health Sciences, University Medical Center/University of Groningen, 9712 CP Groningen, The Netherlands
                [6 ]Department of Economics, Econometrics and Finance, University Medical Center/University of Groningen, 9712 CP Groningen, The Netherlands
                [7 ]GRID grid.38142.3c, ISNI 000000041936754X, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, , Harvard University, ; Cambridge, MA 02115 USA
                [8 ]GRID grid.8391.3, ISNI 0000 0004 1936 8024, Institute of Health Research, Medical School, , University of Exeter, ; Exeter, EX1 2LU UK
                [9 ]GRID grid.7491.b, ISNI 0000 0001 0944 9128, School of Public Health, , Bielefeld University, ; 33615 Bielefeld, Germany
                [10 ]GRID grid.426490.d, ISNI 0000 0001 2321 8086, Centre on Global Health Security, Royal Institute of International Affairs, ; London, SW1Y 4LE UK
                [11 ]FISABIO-Public Health, 46020 Valencia, Spain
                [12 ]GRID grid.482825.1, ISNI 0000 0004 0629 613X, Office of Health Economics, ; London, SW1E 6QT UK
                [13 ]GRID grid.453944.b, ISNI 0000 0000 9642 0149, Meningitis Research Foundation, ; Newminster House, 27-29 Baldwin Street, Bristol, BS1 1LT UK
                [14 ]GRID grid.410513.2, ISNI 0000 0000 8800 7493, Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Inc, ; Collegeville, PA 19426 USA
                [15 ]GRID grid.410513.2, ISNI 0000 0000 8800 7493, Pfizer Inc, ; Collegeville, PA 19426 USA
                [16 ]GRID grid.7497.d, ISNI 0000 0004 0492 0584, German Cancer Research Center (DKFZ), ; Heidelberg, Germany
                Article
                1129
                10.1007/s10198-019-01129-z
                7072054
                31754924
                79b4016a-e98c-4da0-816a-67efa0816ce0
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 29 November 2018
                : 24 October 2019
                Funding
                Funded by: Pfizer Inc
                Categories
                Original Paper
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                Economics of health & social care
                meningitis,meningococcal,vaccine,cost-effectiveness,qaly,i. health, education, and welfare,i.18 government policy, regulation, and public health

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