APPENDIX 18
Neisseria meningitidis B
DISEASE BURDEN
Epidemiology
For the purposes of the calculations in this report, the committee estimated that there are 1,200 new cases of Neisseria meningitidis B (NMB) infection each year in the United States. Approximately half of these occur in children and infants under 5 years of age. Overall mortality rate was estimated at 0.05 per 100,000, or just under 150 deaths per year in the United States. Table A18–1 illustrates the age distribution of new annual NMB infections.
Disease Scenarios
For the purposes of the calculations in this report, the committee estimated that 65% of new cases of NMB manifest as meningitis. The acute manifestations of meningitis require hospitalization (most often in the intensive care unit or ICU). The committee-estimated health utility index (HUI) associated with those states ranges from 0.24 to 0.39 for those requiring ICU and non-ICU hospitalization, respectively.
Just fewer than 10% of patients with NMB meningitis have acute complications, such as gangrene, arthritis, and cardiac involvement. These complications were associated with a HUI of 0.27. Approximately 3.25% of patients experi-
See Appendix 28 for more information.
Table A18–1 Incidence and Mortality Rates for Neisseria meningitidis B Epidemiology
Age Groups |
Population |
Incidence Rates (per 100,000) |
% Distribution of Cases |
<1 |
3,963,000 |
8.78 |
0.2900 |
1–4 |
16,219,000 |
1.48 |
0.2000 |
5–14 |
38,056,000 |
0.33 |
0.1057 |
15–24 |
36,263,000 |
0.33 |
0.1007 |
25–34 |
41,670,000 |
0.27 |
0.0927 |
35–44 |
42,149,000 |
0.20 |
0.0704 |
45–54 |
30,224,000 |
0.20 |
0.0505 |
55–64 |
21,241,000 |
0.20 |
0.0355 |
65–74 |
18,964,000 |
0.20 |
0.0317 |
75–84 |
11,088,000 |
0.20 |
0.0185 |
85+ |
3,598,000 |
0.20 |
0.0060 |
Total |
263,435,000 |
0.46 |
1.0017 |
|
Total cases |
1,200 |
|
Age Groups |
Population |
Mortality Rates (per 100,000) |
% Distribution of Cases |
<1 |
3,963,000 |
1.05 |
0.2900 |
1–4 |
16,219,000 |
0.18 |
0.2000 |
5–14 |
38,056,000 |
0.04 |
0.1057 |
15–24 |
36,263,000 |
0.04 |
0.1007 |
25–34 |
41,670,000 |
0.03 |
0.0927 |
35–44 |
42,149,000 |
0.02 |
0.0704 |
45–54 |
30,224,000 |
0.02 |
0.0505 |
55–64 |
21,241,000 |
0.02 |
0.0355 |
65–74 |
18,964,000 |
0.02 |
0.0317 |
75–84 |
11,088,000 |
0.02 |
0.0185 |
85+ |
3,598,000 |
0.02 |
0.0060 |
Total |
263,435,000 |
0.05 |
1.0017 |
|
Total deaths |
144 |
ence neurologic sequelae lasting a lifetime. These sequelae were estimated to be associated with an HUI of 0.6.
The committee estimated that 35% of new cases of NMB manifest as bacteremia and sepsis. Approximately half of these cases require ICU hospitalization, such as those with Waterhouse Friederichsen syndrome. The HUI associated with bacteremia range from 0.16 to 0.71. Approximately 5.25% of patients experience complications and just over 1% experiences sequelae, such as amputation, that last a lifetime.
Table A18–2 illustrates the estimated number of cases in each health state, the duration of time that state is experienced, and the HUI associated with each state.
Table A18–2 Disease Scenarios for Neisseria meningitidis B Infection
|
No. of Cases |
% of Cases |
Committee HUI Values |
Duration (years) |
MENINGITIS |
780 |
65.00% |
|
|
Meningitis (ICU) |
624 |
52.00% |
|
|
ICU |
|
0.24 |
0.0055 (2 days) |
|
inpatient after ICU |
|
0.28 |
0.0137 (5 days) |
|
Meningitis (no ICU) |
156 |
13.00% |
|
|
inpatient |
|
0.39 |
0.0137 (5 days) |
|
Meningitis—complications |
117 |
9.75% |
|
|
acute complications (gangrene, arthritis, heart failure, etc.) |
|
0.27 |
0.0274 (10 days) |
|
Meningitis—sequelae |
39 |
3.25% |
|
|
neurologic sequelae (cranial nerve damage, deafness, etc.) |
|
0.60 |
23.2209 (discounted quality adjusted life expectancy at average age at onset) (average age at onset=18.3) |
|
BACTEREMIA/SEPSIS |
420 |
35.00% |
|
|
Bacteremia/Sepsis |
210 |
17.50% |
|
|
ICU (Waterhouse Friederichsen) |
|
0.16 |
0.0110 (4 days) |
|
inpatient after ICU |
|
0.44 |
0.0274 (10 days) |
|
Bacteremia/Sepsis (hospitalization; no ICU) |
210 |
17.50% |
0.71 |
0.0137 (5 days) |
Bacteremia/Sepsis—complications |
63 |
5.25% |
0.59 |
0.0274 (10 days) |
acute complications (cardiac, DIC, pneumonia, etc.) |
|
|||
Bacteremia/Sepsis—sequelae |
13 |
1.05% |
0.63 |
23.2209 (discounted quality adjusted life expectancy at age 18) (average age at onset) |
COST INCURRED BY DISEASE
Table A18–3 summarizes the health care costs incurred by NMB infections. For the purposes of the calculations in this report, it was assumed that patients with meningitis incur costs associated with hospitalization (hospital costs, specialist physicians, diagnostics). Patients who experience complications incur additional hospitalization costs. The small percentage of patients who
Table A18–3 Health Care Costs Associated with Neisseria meningitidis B Infection
|
% with Care |
Cost per Unit |
Units per Case |
Form of Treatment |
Meningitis (ICU) |
|
|||
uncomplicated |
100% |
$7,000 |
1.0 |
hospitalization |
|
100% |
$150 |
3.0 |
physician b |
100% |
$50 |
1.0 |
medication b |
|
100% |
$100 |
1.0 |
diagnostic b |
|
10% |
$500 |
1.0 |
diagnostic c |
|
Meningitis—complications |
|
|||
acute complications (gangrene, arthritis, heart failure, etc) |
100% |
$7,000 |
1.0 |
hospitalization |
|
100% |
$150 |
6.0 |
physician b |
100% |
$50 |
1.0 |
medication b |
|
100% |
$100 |
1.0 |
diagnostic b |
|
100% |
$500 |
1.0 |
diagnostic c |
|
Meningitis—sequelae |
|
|||
neurologic sequelae (cranial nerve damage, deafness, etc) |
100% |
$100 |
6.0 |
physician b (per year) |
Bacteremia/Sepsis |
|
|||
ICU (Waterhouse Friederichsen) |
100% |
$4,000 |
1.0 |
hospitalization |
|
100% |
$100 |
3.0 |
physician b |
Bacteremia/Sepsis (no ICU) |
|
|||
inpatient |
100% |
$4,000 |
1.0 |
hospitalization |
|
100% |
$100 |
3.0 |
physician b |
100% |
$100 |
1.0 |
diagnostic b |
|
Bacteremia/Sepsis—complications |
|
|||
acute complications (cardiac, disseminated intravascular coagulation, pneumonia, etc.) |
100% |
$4,000 |
1.0 |
hospitalization |
|
100 % |
$100 |
3.0 |
physician b |
100% |
$500 |
1.0 |
diagnostic c |
|
20% |
$7,000 |
1.0 |
amputation |
|
20% |
$500 |
2.0 |
surgical staff |
|
20% |
$3,000 |
1.0 |
rehabilitation |
experience neurologic sequelae incur costs associated with multiple visits per year to a specialist and therapists for the duration of their life.
Costs associated with NMB-related bacteremia and sepsis include hospitalization and related expenses (physicians, diagnostics). Those who experience complications incur additional costs associated with hospitalization and rehabilitation for the small number of patients who require amputation.
VACCINE DEVELOPMENT
The committee assumed that the development of an NMB vaccine is feasible and that licensure can occur within the middle of the time frame within the charge. The estimates for the model are that it will take 7 years until licensure and that $300 million needs to be invested. Table 4–1 summarizes vaccine development assumptions for all vaccines considered in this report.
VACCINE PROGRAM CONSIDERATIONS
Target Population
The committee’s model assumes that immunization with this vaccine will occur only during infancy. It is estimated that 90% of infants will receive the immunization.
Vaccine Schedule, Efficacy, and Costs
The committee estimated that this would be a relatively low-cost vaccine, costing $50 per dose. Vaccine administration would cost an additional $10. The committee has accepted default assumptions that this vaccine will require a series of 3 doses and that effectiveness will be 75%. Table 4–1 summarizes vaccine program assumptions for all vaccines considered in this report.
RESULTS
If a vaccine program for N. meningitidis B were implemented today and the vaccine were 100% efficacious and utilized by 100% of the target population, the annualized present value of the QALYs gained would be 2,300. Using committee assumptions of less-than-ideal efficacy and utilization and including time and monetary costs until a vaccine program is implemented, the annualized present value of the QALYs gained would be 1,100. The mortality accounts for a large portion of the lost QALYs, due primarily to the deaths in children and infants. QALY loss associated with morbidity is largely due to the lifetime sequelae associated with both meningitis and bacteremia.
If a vaccine program for N. meningitidis B were implemented today and the vaccine was 100% efficacious and utilized by 100% of the target population, the annualized present value of the health care costs saved would be $6 million. Using committee assumptions of less-than-ideal efficacy and utilization and
including time and monetary costs until a vaccine program is implemented, the annualized present value of the health care costs saved would be $2.9 million.
If a vaccine program for N. meningitidis B were implemented today and the vaccine was 100% efficacious and utilized by 100% of the target population, the annualized present value of the program cost would be $720 million. Using committee assumptions of less-than-ideal efficacy and utilization and including time and monetary costs until a vaccine program is implemented, the annualized present value of the program cost would be $450 million.
Using committee assumptions of time and costs until licensure, the fixed cost of vaccine development has been amortized and is $9 million for a N. meningitidis B vaccine.
If a vaccine program were implemented today and the vaccine was 100% efficacious and utilized by 100% of the target population, the annualized present value of the cost per QALY gained is $300,000. Using committee assumptions of less-than-ideal utilization and including time and monetary costs until a vaccine program is implemented, the annualized present value of the cost per QALY gained is $400,000.
See Chapters 4 and 5 for details on the methods and assumptions used by the committee for the results reported.
READING LIST
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