Cost-effectiveness of 4CMenB Vaccination Against Gonorrhea: Importance of Dosing Schedule, Vaccine Sentiment, Targeting Strategy, and Duration of Protection

Background Observational evidence suggests the 4CMenB meningococcal vaccine may partially protect against gonorrhea, with 1 dose being two-thirds as protective as 2 doses. We examined the cost-effectiveness of vaccinating men who have sex with men (MSM) in England, with 1- or 2-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 1 or 2 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 pound (95% credible interval [CrI], 1.15-17.52) and gains 81.41 (95% CrI, 28.67-164.23) quality-adjusted life-years (QALYs) over 10 years; VoD (2-dose) saves 3.40M pound (95% CrI, .48-7.71) and gains 41.26 (95% CrI, 17.52-78.25) QALYs versus no vaccination. Optimistic versus pessimistic vaccine-sentiment assumptions increase net benefits by approximately 30% (VoD) or approximately 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. Targeted vaccination of higher-risk MSM in England is cost-saving regardless of uptake level, even under conservative assumptions about population vaccine sentiment and duration of vaccine protection. Two-dose primary vaccination saves more money and gains more QALYs than 1-dose vaccination.