1. What is cost effectiveness?
• There are infinite demands on our NHS, but a limited pot of money
• Cost effectiveness analysis is a tool to help decide which interventions
offer the best value for money and should be made available on the NHS
• In theory, interventions that are low cost, but have high benefits in terms
of health gains take priority over those with high costs and low health gains
Costs
• NHS costs of the
health intervention
minus the NHS costs
saved by the
intervention
• Measured in £
Benefits
• Health benefits gained
by preventing /treating
the health problem
• Measured in quality of
life years (QALYs)
• 1 QALY = 1 year at full
health
*NHS costs also include personal social services costs

2. The cost effectiveness threshold
• The NHS is currently valued at £20,000/QALY
• All new interventions should cost £20,000/QALY or less, otherwise the
NHS becomes less efficient (we end up spending more money on a given
amount of health)
Years of life saved
PLUS
Quality of life saved from
preventing disease
Vaccination costs
MINUS
Cost savings to NHS and
social services from
preventing disease
The cost effectiveness assessment of Bexsero on which the JCVI based their
interim statement gave a result which was considerably higher than £20,000 so
they could not recommend the vaccine for routine use

3. Was the JCVI interim opinion correct?
• A cost effectiveness model is a simplification
of reality
• The answer you get depends on the
parameters that you feed into the model
• MRF argued that the parameters
underpinning the burden of meningococcal
disease were undervalued