Modelling the epidemiological impact and cost-effectiveness of possible changes to the meningococcal vaccination schedule for adolescents and young adults in the United States
Bibliographic record
Abstract
BACKGROUND: The U.S. adolescent meningococcal vaccination schedule includes a quadrivalent meningococcal conjugate vaccine (MenACWY) dose at 11–12 years, a booster at 16 years, and—through shared clinical decision-making—a meningococcal serogroup B vaccine (MenB) series at 16 years and 6 months later (Q-QB-B schedule). This study evaluates the public health impact and cost-effectiveness of possible revisions to the schedule, considering the options currently under review by the Advisory Committee on Immunization Practices (ACIP). METHODS: We used a static, incidence-based population model to compare invasive meningococcal disease (IMD) incidence and mortality, quality-adjusted life years (QALYs), and costs. The model focused on serogroup B, C, W, and Y disease in a cohort of 11–25-year-olds. Incremental outcomes were estimated per year of incidence from the societal perspective for different schedules compared to Q-QB-B, applying a lifetime horizon to long-term IMD consequences. RESULTS: With Q-QB-B, 50 IMD cases were estimated to occur annually, resulting in 296 QALYs lost and total costs of $1.6 million (M). The N-P-B schedule (which eliminates the MenACWY dose at 11–12 years, replaces MenACWY and MenB with the pentavalent vaccine [MenABCWY] at age 16 years, and maintains administration of a MenB dose 6 months later) was less effective than Q-QB-B, leading to 13.7 additional IMD cases annually. It was also less costly, resulting in $599 M in savings and an incremental cost-effectiveness ratio (ICER) of $6.0 M per QALY lost. Relative to Q-QB-B, the Q-P-B schedule was estimated to avoid 1.5 additional IMD cases annually; all due to serogroup B, consistent with higher vaccination coverage against this serogroup in the Q-P-B schedule in which the second MenACWY dose and the first MenB dose at age 16 are replaced by MenABCWY. The additional costs for Q-P-B relative to Q-QB-B were estimated at $36.8 M and the ICER at $4.5 M per QALY gained. CONCLUSIONS: Q-QB-B was the most cost-effective schedule. Scenarios replacing the MenACWY dose at age 16 years with MenABCWY were not cost-effective vs. Q-QB-B. While cost savings could result from eliminating the first MenACWY dose, this was estimated to result in increased IMD incidence with associated mortality and morbidity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.011 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".