Is the Meningitis B Vaccine ‘Cost-Effective’ in the UK?

In the UK, there is an ongoing debate between the government’s health leaders and parents of infants regarding the current meningitis B vaccination policy.

And this debate focuses on finances, not vaccine efficacy.

Meningitis B is a bacterial infection that most often affects children younger than one year old. 

Meningococcal infections tend to come in bursts. In the past 20 years, between 500 and 1,700 people every year, mainly babies and young children, have developed MenB disease, with around 1 in 10 dying from the infection.

Many of those who survive are left with long-term problems, such as amputation, deafness, epilepsy and learning difficulties. 

The UK’s National Health Service (NHS) offers free meningitis B vaccinations at 2 months of age, with further doses at 4 and 12 months.

But, 820,000 people filed a petition calling for ‘all children to be vaccinated’.

This request has been rejected by the NHS as "not cost effective.”

The NHS is advised by a committee of independent experts regarding immunization policy, which focuses on protecting those with the highest risk of disease.

The Joint Committee on Vaccination and Immunisation (JCVI) is the independent expert committee that advises ministers on the introduction of new, and changes to existing, immunisation programmes in the UK.

In 2015, the JCVI recommended that MenB immunization should be routinely offered to the group of children at the highest risk, who are infants at two months of age. With additional MenB doses at four months and 12 months, provided that the vaccine could be procured at a cost-effective price.

By May 2017, all children under the age of two years in the UK were offered the vaccine, says Public Health England.

The MenB vaccine was and still is, available for a small number of older children and adults who are at increased risk of infection, such as those with no spleen.

When any new immunization programme is introduced, there are eligibility criteria. Moreover, resources should be used to benefit the most people, says the World Health Organization.  

Like any budget, the NHS budget is a limited resource. Therefore, it is essential that JCVI’s recommendations are underpinned by evidence of “cost-effectiveness”.

According to the JCVI, cost-effectiveness analyses systematically consider diminishing returns to finding unvaccinated people, and herd immunity, which needs to be quantified.

Additionally, cost-effectiveness analyses of vaccination programmes should consider the impact of avoiding a future epidemic.

On February 26, 2018, the NHS published ‘Consultation on the Cost-Effectiveness Methodology for Vaccination Programmes and Procurement (CEMIPP) Report’ 

The CEMIPP report gives 27 detailed recommendations, and intended them to be “viewed as a package”.

Three of the recommendations are:

• Lowering of the cost-effectiveness threshold from £20,000 per QALY to £15,000 per QALY.
• Lowering of the discount rate for health impacts from 3.5% per year to 1.5% per year.
• An indefinite time horizon of analysis (i.e. the time period over which impacts of a vaccine are considered), with the inclusion of a sensitivity test to account for a lower discount rate.

The CEMIPP review emphasized that these changes should be considered together, especially due to a number of interdependencies between some of the recommendations, particularly the time horizon and discount rate.

The deadline for responding to this report's recommendations is May 21, 2018. If you have any comments on this vaccination consultation process, details on how to respond are at Annex D.