Public health impact and cost-effectiveness of revising the adolescent meningococcal vaccine schedule in the United States

Abstract

BACKGROUND: In 2025, invasive meningococcal disease (IMD) vaccination in United States (US) adolescents consisted of two standard of care (SoC) schedules: Q-Q-B-B (routine MenACWY [Q] at ages 11 and 16 years; MenB [B] under shared clinical decision-making [SCDM] at age 16 years and 6 months later) or Q-P-B (routine MenACWY at ages 11 and 16 years; MenABCWY [P] at age 16 years and MenB under SCDM 6 months later). We assessed public health impact (PHI) and cost-effectiveness (CE) of intervention strategies on the basis of potential implementation options and revisions to the adolescent meningococcal vaccine schedule proposed in June 2024 by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

METHODS: A model utilizing epidemiological and economic inputs compared projected outcomes for 27 intervention strategies (distinguished by vaccine type [Q, P, and/or B], recommendation type [routine, risk-based], and dosing interval for MenB-containing vaccines [0,6-month , 0,24-month]) versus no vaccination or SoC over 15 years (2025-2039). Discounted outcomes (societal perspective) included IMD cases, deaths, and quality-adjusted life-year losses averted; total direct and indirect costs; and incremental CE ratios.

RESULTS: Retaining routine MenACWY at age 11-12 years and including routine or risk-based MenB-containing vaccines at age 16 years improved PHI versus SoC, particularly with 0,6-month dosing interval for MenB-containing vaccines. Five strategies incorporating MenABCWY improved PHI and were cost-saving versus SoC: Q-Q-B-B.

CONCLUSIONS: Adolescent meningococcal vaccine schedule revisions retaining routine MenACWY and incorporating risk-based or routine MenABCWY may increase PHI in a cost-effective manner, minimizing the humanistic and economic burden of IMD.