Economic evaluation of vaccination strategies in China: A systematic review

Studies on vaccine economic evaluation in mainland China have grown rapidly. To support the improvements regarding how the vaccine economic evaluation studies are designed and conducted, and to provide an overview on the cost-effectiveness levels of different vaccines or vaccination strategies in China setting, this systematic review comprehensively collected and evaluated vaccines economic evaluation studies in mainland China and descriptively synthesize the cost effectiveness findings reported by those high-quality studies. A search of nine electronic databases was conducted in July 2023 and Joanna Briggs Institute (JBI) criteria was used to assess the methodological quality of the included studies. The cost and benefit effectiveness/utitlity/benefits and costs outcomes of included studies were manifested in a decision matrix following the JBI guideline on presenting outcomes for an economic evaluation. A total of 133 studies were included and evaluated 20 types of vaccines. The major comparisons were whether to be vaccinated and whether to be included in national immunization program. The evaluation results of 36 studies being evaluated as high-quality were positioned in decision matrix, and it is found that except for the evaluation for human papillomavirus vaccine (HPV), the conclusions of different included studies about the same vaccination strategies were all in the same quadrant. The majority of vaccination strategies showed the incremental cost-effectiveness ratio (ICER) were lower than gross domestic product (GDP) per capita or three times of GDP per capita. Based on descriptive comparison of evaluation results reported by high quality studies, the tentative recommendations for expanding vaccine coverage include the vaccination of hepatitis A and E, domestic HPV-2, pneumococcal conjugate vaccine-13 (PCV-13), influenza and Hib. The methodology quality assessment in this systematic review suggested that the quality of economic evaluation studies on vaccination strategies in China is dependent on more high-quality primary studies in China setting, including efficacy or effectiveness of vaccine, relevant disease epidemiology and disease burden studies. • 133 vaccine economic evaluations in mainland China systematically reviewed. • Most vaccines showed ICER <1-3×GDP per capita. • Methodology improvement relies on local data: efficacy & disease burden. • Coverage expansion advised: HepA/E, HPV-2, PCV-13, flu & Hib.