Economic evaluation of the introduction of 4CMenB (Bexsero®) in the national vaccine schedule in Spain

Introduction: Bexsero (R) (4CMenB), meningococcal B vaccine, was licensed in Europe in 2013. In Spain, despite MenB being the most frequent cause of invasive meningococcal disease (IMD), Bexsero (R) is recommended and financed for patients at increased risk of IMD but is not financed by the NHS in the routine vaccination schedule. Objective: to evaluate the cost-utility, epidemiological impact, and total costs of the introduction of 4CMenB into the vaccination schedule to help inform vaccine policy in Spain. Method: We adapted a cost-utility analysis, a probabilistic decision-tree, to Spain. A cohort of newborn infants in 2015 was modelled with two dosages, using two different strategies: routine vaccination schedule with 4CMenB and non-vaccination. Costs were measured from a payer perspective and benefits were calculated in quality-adjusted life years (QALYs). A Monte Carlo analysis and 32 scenarios were performed to assess the robustness and the uncertainty of our results. Results: With the 3+1 dosage, routine vaccination prevented 54% of cases and deaths and an incremental cost-utility ratio (ICUR) of 351.389 (sic)/QALY (95% confidence interval [95%CI]: 265,193-538,428) was estimated. The 2+1 dosage prevented 50% of cases and deaths, with an ICUR of 278.556 (sic)/QALY (95%CI: 210,285-430,122). Conclusions: Given the current incidence of invasive meningococcal disease in Spain and the information available from 4CMenB, our model shows that routine vaccination is not cost-effective at the current price. Only with a vaccine price of 1.45 (sic) for the 3+1 schedule or 3.37 (sic) for the 2+1 schedule could it be recommended based on efficiency criteria. (C) 2019 SESPAS. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).