Cost-effectiveness of 4CMenB vaccination against gonorrhea: importance of dosing schedule, vaccine sentiment, targeting strategy, and duration of protection

Dariya Nikitin; Lilith K Whittles; Jeffrey W Imai-Eaton; Peter J White

doi:10.1093/infdis/jiae123

Cost-effectiveness of 4CMenB vaccination against gonorrhea: importance of dosing schedule, vaccine sentiment, targeting strategy, and duration of protection

J Infect Dis. 2024 Apr 17:jiae123. doi: 10.1093/infdis/jiae123. Online ahead of print.

Authors

Dariya Nikitin¹, Lilith K Whittles¹, Jeffrey W Imai-Eaton^{1

2}, Peter J White^{1

3}

Affiliations

¹ MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London W2 1PG, UK.
² Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA 02115, USA.
³ Modelling & Economics Unit, UK Health Security Agency, London NW9 5EQ, UK.

PMID: 38630583
DOI: 10.1093/infdis/jiae123

Abstract

Background: Observational evidence suggests the 4CMenB meningococcal vaccine may partially protect against gonorrhea, with one dose being two-thirds as protective as two. We examined the cost-effectiveness of vaccinating men-who-have-sex-with-men (MSM) in England, with one- or two-dose primary vaccination.

Methods: Integrated transmission-dynamic health-economic modeling explored the effects of targeting strategy, first- and second-dose uptake levels, and duration of vaccine protection, using observational estimates of vaccine protection.

Results: Vaccination with one or two primary doses is always cost-saving, irrespective of uptake, although vaccine sentiment is an important determinant of impact and cost-effectiveness. The most impactful and cost-effective targeting is offering "Vaccination-according-to-Risk" (VaR), to all patients with gonorrhea plus those reporting high numbers of sexual partners. If VaR is not feasible to implement then the more-restrictive strategy of "Vaccination-on-Diagnosis" (VoD) with gonorrhea is cost-effective, but much less impactful. Under conservative assumptions, VaR(2-dose) saves £7.62M(95%CrI:1.15-17.52) and gains 81.41(28.67-164.23) QALYs over 10 years; VoD(2-dose) saves £3.40M(0.48-7.71) and gains 41.26(17.52-78.25) QALYs versus no vaccination. Optimistic versus pessimistic vaccine-sentiment assumptions increase net benefits by ∼30%(VoD) or ∼60%(VaR).

Conclusions: At UK costs, targeted 4CMenB vaccination of MSM gains QALYs and is cost-saving at any uptake level. Promoting uptake maximizes benefits and is an important role for behavioral science.

Keywords: 4CMenB; Bexsero; cost-effectiveness; gonorrhea; transmission-dynamic modeling; uptake; vaccination; vaccine schedule; vaccine sentiment; vaccine targeting.