OBJECTIVES: Vaccine reimbursement and inclusion in national immunization programme is time consuming process among different countries in EU. The objective of the study was to identify trends and key challenges associated with reimbursement of vaccines in Europe.

METHODS: A systematic search was conducted in electronic databases (EMBASE^® & Medline) from database inception till 30 May 2019. The search was supplemented by country specific HTA websites, bibliography searching

RESULTS: The SLR retrieved nine publications reporting trends and challenges with vaccine reimbursement. Across 16 European countries, 19 vaccines were assessed for inclusion in universal mass vaccination (UMV) program. 42% of the 19 vaccines were recommended for children/adolescent UMV, while 17% (of 6) vaccines were recommended for older adults across European countries. In contrast, none of the vaccines for adult UMV were recommended across all European countries. Along with differences in recommendations, reimbursement status varied across countries. It was observed that all recommended vaccines were reimbursed in Italy, while only 19% of recommended vaccines were reimbursed in Bulgaria for children. Variation was also observed for older adults with all recommended vaccines as fully reimbursed in Germany and Italy and none in Austria. In contrast, all recommended vaccines were either fully reimbursed or with co-payment for adults. The results showed variation in recommendation and reimbursement of vaccines across age groups and countries. The variations may be attributed to different methods of assessment across countries with some countries following systematic framework, SLR, economic evaluations, while some countries like Bulgaria not following any standard procedures. Additionally, unknown long-term impact of vaccines, variations in assumptions, methods of extrapolation lead to uncertainties in clinical and cost-effectiveness.

CONCLUSIONS: There is a need for developing standard procedures designed specifically for vaccine assessment. HTA can help immunization policies by ensuring that methodology assesses the value of vaccination programs and not just effectiveness.