Questions and discussion about the costs involved in rolling out the Meningitis B vaccine

[Myredcardigan]

Partly a TAAT but obviously it's all over the news and Sugar has specifically asked me to start this thread to begin constructive debate.

So, from my pov, I totally get the massive cost implications of vaccinating all those under 11. However, id like to hear from anyone who is in the know and can tell me if link to data showing what the actual cost would be. I'd also like to see what the cost implications of treating children with the disease are. Both the acute care, which will cover all infected children, but also the long term costs both medically and educationally of treating those children lucky enough to survive but sadly left with life long disabilities. I know from an educational POV that a non mainstream state school place can cost 40% more. Sometimes much more. But I have no idea on the medical side. Questions such as,

-How much does it cost the NHS in acute care costs to treat a child with Men B for 1wk

-What about non acute NHS recovery support inc OT

-If you are the parent of a deaf child or are deaf yourself, can you comment on the cost implications of supporting your child (rightfully) both medically and educationally?

-Can anyone comment on the NHS and educational costs involved in supporting a child who is an amputee?

Any other relevant stats and info please add to the thread. Please remember that Sugar has asked for this thread to be put out there. Of course, from a personal perspective I don't think any of this should matter but should the petition get its debate then this is what they'll be looking at.

Bump

Before we look at the costs, should we not be asking ourselves why the vaccine insert itself says 'not suitable for children aged under 10yrs'

Black triangle vaccine at present. Really not the best vaccine to be pushing out for everyone to be a human guineapig trial for?

Does it really? I've had my children done and I was given the info sheet and I don't recall that at all.

I really do not want this to turn into a vaccine debate thread. 30 children a year are needlessly dying.

Ignoring the antivaxxers and assuming the specialists who have dedicated their whole adult life to medicine, know what they are doing. Another good question is, how many children contract it every year?

The risk groups are under 5's and adolescents (17-19yo).

It's great that in September 2015 we started building herd immunity by rolling this out in the childrens vaccination schedule.

Before this, was there a lot of campaigning for "we MUST fund and find a vaccination for MenB, it's a killer and horrendous!" - no, there was not.

But there have been two deaths recently that have received high numbers of Facebook shares.

It's only £95 X 2 to have your child protected privately. This is within the reach of many people. Would you pay £190 to save your child's life? For those who really can't afford it, they have some protection from the herd immunity being built, and that protection is only going to increase as time goes on.

I don't think we should be spending public money on vaccinating EVERY SINGLE child, when the risk of contracting this is so very low.

This is the JCVI statement on the Men B vaccine. It walks you through how they came to their decision - weighing up incidence/cost/potential effectiveness of vaccine etc.

They don't give you the full insert. You get the 'brief' version (the same as you get with lots of other vaccines and drugs)

My sister had meningococcal meningitus as a two year old. Very nearly died and was left with lasting brain damage. So far to say, I would snap the hand off anyone offering a safe vaccine. I did the research thoroughly. There are reasons this vaccine wasn't offered as a full roll out and I'm fairly certain it's due in part to the dangers of being sued due to vaccine damage.

I agree. 30 children is 30 too many. But if the alternative is 100's+ with lasting vaccine damage, I'm not sure that's a price I'm willing to pay.

By the way, my children are fully vaccinated, so I'm not an 'anti-vaxxer'.

It's only £95 X 2 to have your child protected privately. This is within the reach of many people.

Where?! £160+ each here.

Starutopia not really the point of the thread though is it. Perhaps you should start another thread instead of derailing this one.

Boots Disappointed. They're out of stock for the next few months though.

All I know is one of my best friends, a GP, has posted the link to the petition in favour of extending vaxx on FB today. An intelligent, thoughtful & very clued-up person, they won't have done that without good reason/evidence. Not had chance to discuss it with them yet.

I don't think it's a sensible use of NHS funds at the moment when the experts are saying they're not convinced it works.

The risks of contracting meningitis are still comparatively low so I'm not planning to pay privately to vaccinate my DS yet. I'd rather wait a little longer until more information is available.

www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM431447.pdf

Vaccine insert. BEXSERO is a vaccine indicated for active immunization to prevent invasive disease caused by Neisseria meningitidis serogroup B. BEXSERO is approved for use in individuals 10 through 25 years of age. (1)

ie NOT approved for children under the age of 10...

Ok. Fair point.

The meningitis charities (Meningitis Now) might be able to help with stats and costs as they have contact with families affected by the disease.

My dd had meningitis as a baby and thankfully survived with minimal side effects.

Despite that, the costs for her care would include hospitalisation for 2 weeks, including several days in HDU, brain scan, lumbar puncture, medication etc. Follow up appointments with the consultant and yearly hearing tests, as she has a mild hearing loss caused by meningitis.

Re use of NHS funds; what I'm trying to work out is if the cost implications of dealing with those children left permanently disabled and how that stacks up against the one off catch up cost.

I've just read up on the black triangle and it appears to be standard for all new vaccines until they reach a certain level of data.

Thank you for the link, Bumbley. I read to pg7. It talks a lot about cost effectiveness and does mention possible litigation but I couldn't see any other details about the parimiters of what was meant by cost effectiveness.

There will be cost implications if children are left with disabilities due to vaccine damage though. I'm totally pro-vaccination, by the way, but if looking at costs, we need to see all angles.

MyRedCardigan: This is from the JCVI interim position statement :

"The study followed the methodology of the National Institute of Health and Care Excellence (NICE) to estimate cost effectiveness. It included sensitivity analyses to assess the influence of key and uncertain parameters including: vaccine efficacy against meningococcal carriage; vaccine coverage against meningococcal strains; the incidence of invasive meningococcal disease (IMD); the quality of life losses from IMD; the rate of medically attended fever following vaccination; vaccine price; and discounting rates."

The final statement (posted above) added:

"The changes made were:
• Revision of quality of life losses to include additional quality of life losses associated with the short term phase of IMD
• Inclusion in the base case model of a quality of life adjustment factor agreed by the JCVI in June 2013 (as opposed to this being accounted for in an additional analysis as had been done previously)
• An increased incidence of disease, considered by the Committee more representative of average incidence over a longer period
• Inclusion of new data on the rate of minor and severe sequelae following IMD
• Inclusion of a proportion of litigation costs associated with meningococcal disease in
the NHS
• Inclusion of quality of life losses to family members."

"So, from my pov, I totally get the massive cost implications of vaccinating all those under 11. However, id like to hear from anyone who is in the know and can tell me if link to data showing what the actual cost would be. I'd also like to see what the cost implications of treating children with the disease are. Both the acute care, which will cover all infected children, but also the long term costs both medically and educationally of treating those children lucky enough to survive but sadly left with life long disabilities. I know from an educational POV that a non mainstream state school place can cost 40% more. Sometimes much more. But I have no idea on the medical side. Questions such as, "

The affects of meningitis are unpredictable. Some people make a good recovery, others need round the clock nursing for life. It really is like Russian Rouette.

I knew a young lad who had meningitis at eight years old. He lost all his speech, had to learn how to walk again and has the level of common sense of a two year old. He will never live independently and I doubt it's possible to put a financial cost on his disablity. He was transferred to a special school, but there are costs of respite and transport.

In someways the suriviors who are left with profound medical complications are in a worse position than those who die.

It's important that the risks of vaccine damage or side affects is considered. The risk of catching menengitis needs to be more than getting vacinne damage. The severity of the vacinne damage may still be less than potential damage caused by menengitis.

This is also from that interim statement:

"JCVI noted that clinical trials show that the antibody responses provided by the primary infant schedule of Bexsero® wane rapidly and differ between the four vaccine components complicating assessment of the duration of protection. Data on the persistence of the antibody responses following subsequent boosting and also from primary toddler or adolescent immunisation are more limited."

The link that StarUtopia gave to the vaccine insert shows the antibody response rates in the Immunogenicity section.

Thank you, Bumbley. I did read that bit. I'm confused how you can quantify in monetary terms, the loss of a child's life? (Last point in summary) How is that weighted in terms of cost effectiveness?
So am I right in thinking that they did not consider the costs of acre care treatment? Or the long term costs of caring for a child left disabled? I did read the relevant part but I still can't seem to see that.

I don't mean that to sound emotional. I would assume that those children who sadly lose the battle cost less that those who live but are left with a disability.

So could it be that we realise they need another booster later on?

"Thank you, Bumbley. I did read that bit. I'm confused how you can quantify in monetary terms, the loss of a child's life? (Last point in summary) How is that weighted in terms of cost effectiveness? "

There are lots of conditions that can take a child's life.

The nhs has a limited amount of money. It's difficult to decide how to spend it to best affect. Do we have a vaccination programme for meningitis B or would it be better to vacinnate against chicken pox? One of the complications of chicken pox is meningitis. Perhaps we need more research into treating scepicema.