OBJECTIVES: To estimate, from a broad societal perspective, the expected net monetary benefit (NMB) and benefit-cost ratios of four vaccination programs, including flu, pneumococcal, herpes zoster and respiratory syncytial virus (RSV), across 10 countries worldwide. The benefit-cost analysis (BCA) focuses on adult vaccination programs, with scenario analyses for increased coverage and recommended-age expansion.

METHODS: Single (herpes zoster and pneumococcal) and multi-cohort (flu and RSV) models were developed to estimate the NMBs and BCRs of four (existing or hypothetical in the case of RSV) adult vaccination programs across ten countries: Australia, Brazil, France, Germany, Italy, Japan, Poland, South Africa, Thailand and the US. Infection and disease rates as well as resource utilisation parameters etc. were estimated using 2019 values to reflect non-pandemic times; vaccine efficacy and coverage/uptake parameters were derived from the latest data/recommendations available. Alongside sensitivity analyses, scenario analyses were done to estimate the effects of expanded vaccine coverage and national schedule expansion of recommended vaccination age.

RESULTS: The estimated NMBs are positive and BCRs are >1 in all countries and for all programmes, including herpes zoster, despite assuming no mortality for this. Differences in the magnitude of value exist between programmes and countries yet expanding coverage rates and recommended age improves the NMBs and BCRs across the board. The results are sensitive to the inclusion of broader societal impacts (e.g. productivity effects) and the value of a statistical life used.

CONCLUSIONS: Adult immunisation programmes represent good value for money across a broad variety of settings, and expanding coverage and the recommended age further improves this. The inclusion of broader societal effects is important to avoid underestimating these programmes’ value.