Following the tragic death of our son Zachary Gravatt in 2009 of meningococcal septicaemia, the Coroner made several recommendations, which included: That the MOH reviews at the earliest opportunity the cost benefit of a publically funded vaccination programme for meningococcal C and undertakes appropriate consultation, including with consumers. To the best of our knowledge no such cost benefit analysis has been undertaken. We also note that Mills, Sexton and Carter reviewed in the Journal the success of the meningococcal C vaccination programme in Northland 2011 following an outbreak.1 Dr Graham Mills wrote an editorial in the same edition concluding: Although public health units will continue to fire fight when clusters of serogroup C disease reach predefined threshold levels, has the time now come to include meningococcal C vaccine, a highly effective public health intervention, into New Zealands immunisation schedule? The introduction of such a vaccine intio the vaccination schedule has been proven to be safe and effective with Australia introducing it into their schedule in 2003 following the highly effective experience of the UK in 1999. As a result they are both living with a much decreased burden of C disease than that which currently exists in New Zealand. Since these publications, the responsibility for the New Zealand national immunisation schedule has passed to PHARMAC and there has been much discussion about the possible funding of additional vaccines in particular rotavirus and varicella. A cost-effectiveness study conducted in 2002 and updated in 2006 of the UK meningococcal C vaccination campaign found that the cost per life year saved from the vaccination campaign was estimated to be as low as \u00a32,760 per QALY (depending on the cost of the vaccine) using a vaccination strategy of first vaccination at 12 months with a catch-up vaccination at 18 years of age.2 A cost-effectiveness study from the Netherlands published in 2013 found that routine vaccination with conjugate meningococcal ACWY vaccine was cost saving. We have conducted a preliminary cost-effectiveness analysis of routine meningococcal C vaccine in New Zealand based upon the published and peer-reviewed UK model above. This analysis estimates that a vaccination strategy of first vaccination at 12 months with a catch up vaccination at 18 years of age is cost-neutral at a vaccine cost of $25-40 per dose. I have been unable to find any official mortality data for rotavirus in New Zealand. However, a specific cost-effectiveness study for New Zealand rotavirus vaccination by Milne found an adjusted cost per QALY of $46,092.7 Base Case Estimatesa High Case Estimatesb Vaccine Efficacy 93% 93% Coverageg 90% 100% Invasive Meningococcal C Disease5 mean cases per 100,000 population 2009-2012 0.60 1.05 average case fatality ratec 16.1 16.1 Disease Outcomes, proportion of patients6 skin scarring 7.6 7.6 single amputation 1.9 1.9 multiple amputation 1.2 1.2 hearing loss 8.8 8.8 long-term neurological disability 2.1 2.1 Health Related QALY6 skin scarring 1 1 single amputation 0.70 0.70 multiple amputations 0.61 0.61 hearing loss 0.72 0.72 long-term neurological disability 0.06 0.06 Unit cost of care and treatment parameters Rate of admission to hospital5 96.5 96.5 Rate of admission to intensive care2 14.9 14.9 Mean length of stay in intensive care (days)2 3.5 3.5 Mean length of stay hospital (days)2 7.9 7.9 Mean cost of intensive care per day6 $7,800 $7,800 Mean cost of general ward per day6 $2,700 $2,700 Deaths avoided 3.6 6.9 Mean Total Cost Hospitalisation $560,974 $1,004,688 QALYs Saved5 Life Years Savedf 224.3 434.4 single amputation 6.87 13.08 multiple amputations 5.64 10.74 hearing loss 29.70 56.53 long-term neurological disability 23.79 45.29 TOTAL QALYS Saved 290.26 560.05 Costs of Sequelae2 Moderate ($1,000 per patient per year)d $167,322 $286,660 Severe ($40,000 per patient per year)e $2,064,155 $3,256,360 Annual Vaccination Cost Birth cohort NZ 62,000 62,000 Cost per dose Men C Conjugate Vaccine $25 $40 Cost of Campaign (2 doses per infant) $2,790,000 $4,464,000 Incremental Cost Per QALY -$8.44 -$149.46 a average cases of confirmed meningococcal C 2009-2012 c weighted average CFR for different C strains d single amputation and hearing loss e multiple amputations and long-term neurological disability f mean life expectancy 82.0 years g assumes herd immunity

Following the tragic death of our son Zachary Gravatt in 2009 of meningococcal septicaemia, the Coroner made several recommendations, which included: That the MOH reviews at the earliest opportunity the cost benefit of a publically funded vaccination programme for meningococcal C and undertakes appropriate consultation, including with consumers. To the best of our knowledge no such cost benefit analysis has been undertaken. We also note that Mills, Sexton and Carter reviewed in the Journal the success of the meningococcal C vaccination programme in Northland 2011 following an outbreak.1 Dr Graham Mills wrote an editorial in the same edition concluding: Although public health units will continue to fire fight when clusters of serogroup C disease reach predefined threshold levels, has the time now come to include meningococcal C vaccine, a highly effective public health intervention, into New Zealands immunisation schedule? The introduction of such a vaccine intio the vaccination schedule has been proven to be safe and effective with Australia introducing it into their schedule in 2003 following the highly effective experience of the UK in 1999. As a result they are both living with a much decreased burden of C disease than that which currently exists in New Zealand. Since these publications, the responsibility for the New Zealand national immunisation schedule has passed to PHARMAC and there has been much discussion about the possible funding of additional vaccines in particular rotavirus and varicella. A cost-effectiveness study conducted in 2002 and updated in 2006 of the UK meningococcal C vaccination campaign found that the cost per life year saved from the vaccination campaign was estimated to be as low as \u00a32,760 per QALY (depending on the cost of the vaccine) using a vaccination strategy of first vaccination at 12 months with a catch-up vaccination at 18 years of age.2 A cost-effectiveness study from the Netherlands published in 2013 found that routine vaccination with conjugate meningococcal ACWY vaccine was cost saving. We have conducted a preliminary cost-effectiveness analysis of routine meningococcal C vaccine in New Zealand based upon the published and peer-reviewed UK model above. This analysis estimates that a vaccination strategy of first vaccination at 12 months with a catch up vaccination at 18 years of age is cost-neutral at a vaccine cost of $25-40 per dose. I have been unable to find any official mortality data for rotavirus in New Zealand. However, a specific cost-effectiveness study for New Zealand rotavirus vaccination by Milne found an adjusted cost per QALY of $46,092.7 Base Case Estimatesa High Case Estimatesb Vaccine Efficacy 93% 93% Coverageg 90% 100% Invasive Meningococcal C Disease5 mean cases per 100,000 population 2009-2012 0.60 1.05 average case fatality ratec 16.1 16.1 Disease Outcomes, proportion of patients6 skin scarring 7.6 7.6 single amputation 1.9 1.9 multiple amputation 1.2 1.2 hearing loss 8.8 8.8 long-term neurological disability 2.1 2.1 Health Related QALY6 skin scarring 1 1 single amputation 0.70 0.70 multiple amputations 0.61 0.61 hearing loss 0.72 0.72 long-term neurological disability 0.06 0.06 Unit cost of care and treatment parameters Rate of admission to hospital5 96.5 96.5 Rate of admission to intensive care2 14.9 14.9 Mean length of stay in intensive care (days)2 3.5 3.5 Mean length of stay hospital (days)2 7.9 7.9 Mean cost of intensive care per day6 $7,800 $7,800 Mean cost of general ward per day6 $2,700 $2,700 Deaths avoided 3.6 6.9 Mean Total Cost Hospitalisation $560,974 $1,004,688 QALYs Saved5 Life Years Savedf 224.3 434.4 single amputation 6.87 13.08 multiple amputations 5.64 10.74 hearing loss 29.70 56.53 long-term neurological disability 23.79 45.29 TOTAL QALYS Saved 290.26 560.05 Costs of Sequelae2 Moderate ($1,000 per patient per year)d $167,322 $286,660 Severe ($40,000 per patient per year)e $2,064,155 $3,256,360 Annual Vaccination Cost Birth cohort NZ 62,000 62,000 Cost per dose Men C Conjugate Vaccine $25 $40 Cost of Campaign (2 doses per infant) $2,790,000 $4,464,000 Incremental Cost Per QALY -$8.44 -$149.46 a average cases of confirmed meningococcal C 2009-2012 c weighted average CFR for different C strains d single amputation and hearing loss e multiple amputations and long-term neurological disability f mean life expectancy 82.0 years g assumes herd immunity