OBJECTIVES : Vaccination confers health and economic benefits beyond those traditionally included in cost-effectiveness analyses (CEAs), such as educational and housing impacts. We assessed the frequency of and factors associated with the inclusion of such social impacts in vaccine CEAs.

METHODS : We identified published CEAs of vaccines from 2014-2019 using the Tufts CEA Registry of cost-per-quality-adjusted life year (QALY) studies and Global Health CEA Registry of cost-per-disability-adjusted life year (DALY) evaluations. We also conducted a systematic review of published and grey literature to capture additional studies. We focused on vaccine-preventable disease categories posing the greatest disease burden worldwide: neonatal, diarrheal, lower respiratory, HPV-related, and tuberculosis.

RESULTS : We identified 475 studies, including 328 cost-per-QALY studies, 96 cost-per DALY studies, 4 benefit-cost analyses, and 47 studies that used life years, deaths/cases averted, or other measures. Overall, 58% of studies were conducted from a health care sector perspective, which was consistent across study types. The most commonly included broader impacts in studies employing a societal perspective were productivity among cost-per-QALY studies (25%) and patient transportation in the cost-per-DALY literature (24%). Impacts on education, housing, and other sectors were rarely examined (<3%). Studies set in sub-Saharan Africa (31%; p=.03) were least likely to include broader impacts, while those conducted in upper middle-income settings (52%) or North America (52%) included these elements most frequently. Among commonly-studied diseases, influenza studies were more likely to include broader elements (63%; p<.001), while HPV (29%, p<.001) and varicella/herpes zoster (38%, p=.036) evaluations considered broader impacts less frequently.

CONCLUSIONS : Few vaccine cost-effectiveness studies include broader and nonhealth impacts of vaccination, and measures of the impact of vaccination programs on education, housing, and other sectors are rarely examined. Such exclusions may underestimate the true societal value of vaccines, particularly in lower-income settings that must make complex decisions to prioritize scarce resources.