Cost-Effectiveness of Vaccination Strategies for COVID-19: A Systematic Review

This study aims to provide a comprehensive overview of the cost-effectiveness of COVID-19 vaccination strategies and examine the reporting quality of the included studies.

A systematic search was performed across PubMed, Web of Science, Embase, Cochrane Library, the International Network of Agencies for Health Technology Assessment, and Chinese databases (CNKI, WanFang, VIP, and SinoMed). Health economic evaluations published from inception to December 19, 2024, considering both costs and effects of vaccination strategies for COVID-19 were included. The reporting quality of the included studies was comprehensively assessed according to the Consolidated Health Economic Evaluation Reporting Standards Checklist (CHEERS) 2022. A narrative synthesis was employed to summarize and present the findings across diverse vaccination strategies. To ensure transparency, the study protocol was registered prospectively in the Prospective Register of Systematic Reviews (CRD42025629706).

A total of 68 studies were included. These studies were heterogeneous concerning reporting quality, vaccination strategies, adopted perspective, applied models, and outcome indicator used. The CHEERS quality scoring rate of 68 studies ranged from 23% to 88%, with a median of 71%. Vaccination was consistently found more cost-effective or cost-saving than no vaccination. Prioritizing high-risk populations, particularly older adults, delivered even higher economic benefits across diverse settings.

COVID-19 vaccination remains cost-effective globally. While rapid deployment and high risk prioritization maximize economic benefits, optimal strategies are sensitive to epidemiological and methodological factors, placing substantial demands on policymakers. Future research should integrate long-term impacts, health equity, and reporting standards to strengthen evidence based vaccination policies.