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Costs May Limit Use Of Meningitis B Vaccine

Financial considerations might influence use of a newly approved vaccine targeted at a strain of bacterial meningitis that often strikes college campuses, according to speakers at a conference Thursday in Kansas City, Mo., sponsored by the Mid America Immunization Coalition (MAIC).

The drug in question is Pfizer’s Trumenba, which gained approval from the U.S. Food and Drug Administration in late October. It is the first vaccine aimed at preventing a type of bacterial meningitis known as strain B, a potentially life-threatening disease that attacks the lining surrounding the brain and spinal cord.

But the keynote speaker at the event, Dr. William Atkinson, said that meningitis B is extremely rare, with only about 250 cases in the United States last year. 

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The question, he said, is whether it makes fiscal sense for the government to recommend widespread use of the vaccine when it affects relatively few people.

“It is hard to justify economically to vaccinate millions of people to prevent 250 cases,” Atkinson said, “particularly when a lot of those cases are happening in babies, where the vaccine is not licensed yet.”

The FDA approved the drug for use in people ages 10 to 25.

An expert in vaccines, Atkinson is a former official with the U.S. Centers for Disease Control and Prevention and is now associate director for immunization education at the Immunization Action Coalition in St. Paul, Minn.

He expects the Advisory Committee on Immunization Practices, which is part of the CDC, to make a decision about the recommended usage of Trumenba at its February meeting in Atlanta.

Atkinson said it looks like the committee will make a fairly narrow recommendation on populations that should be vaccinated, including certain immune-suppressed individuals and people in areas that have experienced an outbreak. He does not expect the recommendation to cover college students.

Outbreaks of the strain occurred last year at Princeton University in New Jersey and at the University of California-Santa Barbara.

One Kansas man, Andy Marso, who has become an advocate for meningitis vaccination, contracted meningitis B a decade ago while a student at the University of Kansas.

Marso was recognized at the conference as one of MAIC’s 2014 Immunization Heroes for his advocacy work, particularly on behalf of a Missouri law enacted in July that requires all college students living on campus at public colleges and universities to be vaccinated against meningitis.

(Marso is now a reporter for KHI News Service, a partner in Heartland Health Monitor, a reporting collaborative that includes KCUR, KCPT and Kansas Public Radio.)

The disease claimed the front half of both Marso’s feet and all of his fingers, except for his right thumb, after it compromised blood flow to his extremities.

Marso expressed concern that the three-dose regimen might prove too expensive for patients, at more than the roughly $100 per dose it costs for vaccines for other strains of meningitis.

“There is going to be an issue of cost – no doubt about it,” he said.

Atkinson said insurance will probably cover populations included in recommendations from the CDC but it could be an out-of-pocket expense for others, such as parents who are sending their children to college.

Marso said his illness cost his father’s health insurance $2 million in the first year, including 140 days in the hospital and eight inpatient surgeries.

He said he expects to testify at the CDC committee meeting in February. He said he realized government officials must make a cost-benefit analysis as part of their recommendation on who should receive the vaccination.

But in weighing the scope of their recommendations, he said he hoped the committee would consider the pain and suffering that go along with the after-effects of the disease.

“I hope they also account for people like me who are going to have ongoing medical costs for the rest of their lives because of this,” he said. “That is something that needs to be considered.”

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