A computer-generated model developed by Johns Hopkins Medicine researchers adds to evidence that providing universal vaccination against meningitis B infection to students entering college may be too costly to justify the absolute number of cases it would prevent. The study also suggests that if vaccine developers could significantly lower the price, universal vaccination might be worth requiring on college campuses.
In a report on the cost/benefit estimate published in the American Journal of Preventive Medicine, researchers determined the cost per quality-adjusted life year, or QALY—standard measure of the public policy value of medical interventions—to be $13.9 million if every student entering college in the United States were vaccinated. Historic expenditures and previous research, the investigators say, assume that society is willing to pay $150,000 per QALY.
Put another way, the new study suggests that universal vaccination of the college student population would be considered cost-effective only if a vaccine series cost less than $65; the average current price is $324, according to study authors.
"Despite the poor prognosis of meningitis B infection and the fairly reasonable cost of meningitis B vaccination, the extreme rarity of this infection even amongst its peak in college-age individuals makes universal vaccination cost-ineffective," says lead study author Ira Leeds, a postdoctoral research fellow in the Department of Surgery at the Johns Hopkins University School of Medicine.
"Vaccinating 100,000 college students, for example, would prevent less than five cases of MenB," Leeds adds. "Health care systems and public health programs do not have unlimited funds, and such a small benefit makes support of universal vaccination economically untenable, even when accounting for individual, payer, and community outbreak costs and productivity lost by society."
Although Leeds and his colleagues say their results fail to support a formal universal vaccination program, they caution that their model assumed all college students to have a generally well state of health. They also emphasized that MenB vaccine is safe and effective, and should remain accessible and an individual option. In addition, they say, those at high risk because of compromised immune systems or other pre-existing medical conditions should consider vaccination.
Meningitis B is the most common form of meningococcal infection in young adults in the United States, with about 600 to 1,000 cases reported each year. But it affects only 30 per 100,000 U.S. college students, according to 2017 data gathered by the U.S. Centers for Disease Control and Prevention. The infection, however, is serious, and may cause severe inflammation of the brain and spine, and death in a small number of people. Each year, about 10–15 percent of Americans who contract MenB die.
"Vaccines have become widely available within the past few years," Leeds says, "but there's very little evidence to suggest that they're going to do much good given their high cost in a generally healthy population."
To come up with their results, the investigators developed a computerized "decision tree" algorithm to trace and track the incremental cost-effectiveness and cost per case averted by universal vaccination of incoming students at a midsize U.S. four-year college. They compared those costs against an informal, "random" vaccination program designed to mimic what this population might do if left to decide on its own whether to vaccinate. Each "student" in the model was assumed to be at equal risk for MenB infection and to be entering college at age 18 in generally good health.
Overall, the computer model predicted that a nonformal vaccination program was more cost-effective than universal vaccination from both the health sector and societal perspectives. Vaccinating each entering class of college students would cost an estimated $323,810 per campus per year. By contrast, an outbreak for a campus that would universally vaccinate after a case of infection was identified would cost $2.59 million per campus. Given the low incidence of MenB infections, a universal vaccination program would reduce the number of cases in four years from an estimated 9.2 cases per 1,000 campuses to 4.6 per 1,000 campuses.