Comparative Analysis of Health Economic Evaluations for Different Influenza Vaccines and Vaccination Strategies in China: A Systematic Review

Objective: This study systematically reviews health economic evaluations of influenza vaccines in China and synthesizes the evidence on different vaccine categories. Method(s): We searched databases, including the China Hospital Knowledge Database, Wanfang, PubMed, Web of Science, and Embase, for studies on the health economics of influenza vaccines in China from 2015 to 2024. Studies were selected based on predefined criteria, and relevant data were extracted for analysis. The research utilized a parameter, ICER/threshold, defined as the ICER divided by the GDP per capita, to compare the results of cost-effectiveness analysis (CEA) studies. Result(s): A total of 1743 articles were identified, of which 25 met the inclusion criteria for full-text review. These included 19 Chinese studies and 6 English studies. Study populations were predominantly older adults (52.0%), followed by children, adolescents, people with chronic disease, and pregnant women. Vaccination strategies included trivalent inactivated influenza vaccine (TIV), quadrivalent inactivated influenza vaccine (QIV), trivalent live-attenuated influenza vaccine (LAIV), and non-vaccination groups. For TIV, 94.7% reported positive cost-effectiveness or cost-benefit results, with 21.1% identifying it as the most dominant strategy. For QIV, six studies compared it with a non-vaccinated group, and five (83.3%) reported favorable economic results. The study on LAIV showed cost-effectiveness compared to no vaccination, but not compared to QIV. The ICER threshold for TIV is the most favorable, and the population that exhibits the highest cost-effectiveness and benefit from vaccination is those people with underlying health conditions. Conclusion(s): TIV vaccination is often cost-effective, especially for people with chronic diseases, children, and older adults. Prioritizing TIV vaccination for those people with chronic diseases is recommended. Copyright © 2025 by the authors.