The Cost and Public Health Burden of Invasive Meningococcal Disease Outbreaks: A Systematic Review

Abstract

BackgroundInvasive meningococcal disease (IMD) is a serious disease with a rapid onset, high mortality rate, and risk of long-term complications. Numerous reports in the literature conclude that IMD outbreaks are associated with substantial costs to society and significant burden on communities due to the cost associated with the prevention of secondary cases.ObjectiveTo systematically review the literature on the costs and public health burden associated with IMD outbreaks.MethodsStudies were primarily identified through searching MEDLINE and EMBASE. Reports were included if they provided cost data related to the containment of an IMD outbreak after 1990 and were written in English, French, or Spanish. Costs were converted to 2010 United States dollars. Outbreaks were categorized by low-income countries (LIC) and high-income countries (HIC) based on gross domestic product per capita. Outbreak containment strategies were classified as small (e.g., targeting members of the school/institution where the outbreak occurred) or large (e.g., targeting everyone in the community).ResultsSixteen articles reporting data on 93 IMD outbreaks fulfilled the eligibility criteria and were included. The majority of outbreaks occurred in HIC. Five studies reported the use of small containment strategies including targeted vaccination and chemoprophylaxis, all occurring in HIC. The average cost per small containment strategy was $299,641 and the average cost per IMD case was $41,857. Eight studies reported large containment strategies involving widespread vaccination targeting a specific age group or community. For HIC, the average cost per large containment strategy was $579,851 and the average cost per IMD case was $55,755. In LIC, the average cost per large containment strategy was $3,407,590 and the average cost per IMD case was $2,222.ConclusionIMD outbreaks were associated with substantial costs. We found that although there were numerous reports on IMD outbreaks, data on containment costs were very limited. More research in this area is warranted.

Clinical and economic burden of invasive meningococcal disease: Evidence from a large German claims database

“…The case fatality rate of IMD is high with 5-15% and up to 57% of survivors in adolescents aged 15 to 19 years develop a wide range of sequelae [7][8][9][10][11] such as hearing loss, visual impairment, neurological impairments or limb amputation. As a result, IMD is associated with substantial short-term and long-term costs for health care systems [12][13][14].…”

Meningococcal serogroup Y emergence in Europe

“…meningitidis continues to cause substantial rates of illness, risk of long-term sequelae and death worldwide, and is associated with significant costs. 3,4 The incidence of invasive meningococcal disease (IMD) is highest in infants and young children, with a second, although lower peak of disease among adolescents and young adults. Moreover, incidence of IMD increases in the elderly.…”

The Response to and Cost of Meningococcal Disease Outbreaks in University Campus Settings: A Case Study in Oregon, United States

“…Although this study adds important information to the published literature, there are certainly extensions to this work to consider. Future research should include development of a cost calculator to allow organizations to more-comprehensively estimate and plan for expenses before or during an outbreak, something that is not widely documented (Anonychuk et al, 2013). Because the timing, number of cases, and location of an outbreak all affect the required response activities, more university outbreaks should be examined.…”

“…As such, health care stakeholders (e.g., public health officials, providers) should give attention to gaining a fuller understanding of the complex interactions of parties engaged in the response and the scope of the economic burden associated with the response. To date, there is no comprehensive estimate of the economic burden of an outbreak (Anonychuk et al, 2013). Traditional approaches do not account for the complex nature of an outbreak and therefore may underestimate its true burden.…”