OBJECTIVE: To use mathematical and economic models to predict the 
epidemiological and economic impact of vaccination with Bexsero, designed to 
protect against group B meningococcal disease, to help inform vaccine policy in 
the United Kingdom.
DESIGN: Modelling study.
SETTING: England.
POPULATION: People aged 0-99.
INTERVENTIONS: Incremental impact of introductory vaccine strategies simulated 
with a transmission dynamic model of meningococcal infection and vaccination 
including potential herd effects. Model parameters included recent evidence on 
the vaccine characteristics, disease burden, costs of care, litigation costs, 
and loss of quality of life from disease, including impacts on family and 
network members. The health impact of vaccination was assessed through cases 
averted and quality adjusted life years (QALYs) gained.
MAIN OUTCOME MEASURES: Cases averted and cost per QALY gained through 
vaccination; programmes were deemed cost effective against a willingness to pay 
of £20,000 (€25,420, $32,677) per QALY gained from an NHS and personal and 
social services perspective.
RESULTS: In the short term, case reduction is greatest with routine infant 
immunisation (26.3% of cases averted in the first five years). This strategy 
could be cost effective at £3 (€3.8, $4.9) a vaccine dose, given several 
favourable assumptions and the use of a quality of life adjustment factor. If 
the vaccine can disrupt meningococcal transmission more cases are prevented in 
the long term with an infant and adolescent combined programme (51.8% after 30 
years), which could be cost effective at £4 a vaccine dose. Assuming the vaccine 
reduces acquisition by 30%, adolescent vaccination alone is the most favourable 
strategy economically, but takes more than 20 years to substantially reduce the 
number of cases.
CONCLUSIONS: Routine infant vaccination is the most effective short term 
strategy and could be cost effective with a low vaccine price. Critically, if 
the vaccine reduces carriage acquisition in teenagers, the combination of infant 
and adolescent vaccination could result in substantial long term reductions in 
cases and be cost effective with competitive vaccine pricing.