Public health and economic impact of meningococcal conjugate (MCV4) vaccination in the South African HIV-positive population

Analysis of the costs and benefits of introduction of the MCV4 vaccine in the SA public-sector HIV-positive population on antiretroviral treatment indicates significant public health benefits can be achieved, at current low disease incidence rates, but at a substantially increased cost to the healthcare system. Background. HIV/AIDS places a large burden on the South African (SA) healthcare system. Such patients are at a significantly higher risk of contracting invasive meningococcal disease (IMD) than immunocompetent individuals. The meningococcal conjugate vaccine (MCV4) is indicated for vaccination against IMD.  Objectives. Given the large HIV-positive population in SA, coupled with their increased risk of contracting IMD, the current study analysed the costs and benefits of introduction of the MCV4 vaccine in the SA public-sector HIV-positive population on antiretroviral treatment.  Methods. Dynamic Markov models were developed to model the introduction of the MCV4 vaccine, with a target uptake of 50% over 85 years. Most data were sourced from published literature, with some inputs sourced via Delphi panel consensus.  Results. The public health results indicate that 39 185 cases of IMD (31 355 without sequelae and 7 830 with long-term sequelae) and 1 780 disease-related deaths could be avoided. There was an approximately ZAR47.6 million reduction in indirect costs, but an increase in total cost of approximately ZAR4.485 billion, due to vaccination costs. A base case incremental cost-effectiveness ratio per quality-adjusted life year of ZAR613 805 was obtained.  Conclusion. Significant public health benefits can be achieved by the introduction of the MCV4 vaccine into the public sector for HIV-positive patients on treatment. However, at current low disease incidence rates, introduction of the vaccine would be at a substantially increased cost to the healthcare system.

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