髄膜炎菌ワクチンは男性の淋病予防に費用対効果あり(Meningococcal vaccine is cost effective at protecting men against gonorrhoea)

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2024-04-17 インペリアル・カレッジ・ロンドン(ICL)

髄膜炎菌ワクチンは男性の淋病予防に費用対効果あり(Meningococcal vaccine is cost effective at protecting men against gonorrhoea)

ロンドン帝国大学の研究によると、性感染症である淋病に対する4CMenB髄膜炎菌B型ワクチンの男性同性愛者への接種はコスト効果が高いとされています。この数理モデリング研究は、淋病の感染と経済データを組み合わせて、将来の感染を防ぐためのワクチン接種のコスト効果を評価しました。特にリスクの高い患者にワクチンを提供することで、10年間に57,000件のケースを防ぐことができ、さらに性感染症クリニックを訪れる未感染者にも広げると、140,000件のケースを防げる可能性があります。

<関連情報>

淋病に対する4CMenBワクチン接種の費用対効果:投与スケジュール、ワクチン感情、標的戦略、および防御期間の重要性 Cost-effectiveness of 4CMenB vaccination against gonorrhea: importance of dosing schedule, vaccine sentiment, targeting strategy, and duration of protection

Dariya Nikitin, Lilith K Whittles, Jeffrey W Imai-Eaton, Peter J White
The Journal of Infectious Diseases  Published:17 April 2024
DOI:https://doi.org/10.1093/infdis/jiae123

Abstract

Background
Observational evidence suggests the 4CMenB meningococcal vaccine may partially protect against gonorrhea, with one dose being two-thirds as protective as two. We examined the cost-effectiveness of vaccinating men-who-have-sex-with-men (MSM) in England, with one- or two-dose primary vaccination.

Methods
Integrated transmission-dynamic health-economic modeling explored the effects of targeting strategy, first- and second-dose uptake levels, and duration of vaccine protection, using observational estimates of vaccine protection.

Results
Vaccination with one or two primary doses is always cost-saving, irrespective of uptake, although vaccine sentiment is an important determinant of impact and cost-effectiveness. The most impactful and cost-effective targeting is offering “Vaccination-according-to-Risk” (VaR), to all patients with gonorrhea plus those reporting high numbers of sexual partners. If VaR is not feasible to implement then the more-restrictive strategy of “Vaccination-on-Diagnosis” (VoD) with gonorrhea is cost-effective, but much less impactful. Under conservative assumptions, VaR(2-dose) saves £7.62M(95%CrI:1.15-17.52) and gains 81.41(28.67-164.23) QALYs over 10 years; VoD(2-dose) saves £3.40M(0.48-7.71) and gains 41.26(17.52-78.25) QALYs versus no vaccination. Optimistic versus pessimistic vaccine-sentiment assumptions increase net benefits by ∼30%(VoD) or ∼60%(VaR).

Conclusions
At UK costs, targeted 4CMenB vaccination of MSM gains QALYs and is cost-saving at any uptake level. Promoting uptake maximizes benefits and is an important role for behavioral science.

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