OBJECTIVES: Pertussis incidence has been increasing in adolescents and adults in the last two decades with transmission to vulnerable young infants. This epidemiological changing has raised interest in the cost-effectiveness of booster vaccination (extra administration of a vaccine after an earlier dose). A critical review of economic evaluations of pertussis booster vaccination was performed in order to develop recommendations for future studies. This review illustrates specific challenges encountered in economic evaluations of vaccination programmes.  METHODS: The literature search covered cost-effectiveness studies of pertussis booster vaccination, published until November 2010, worldwide. We extracted information on model structures, input data and results. RESULTS: We identified 13 publications (9 distinct models) referring to cost-effectiveness of pertussis booster vaccination. The most frequently studied strategies were adolescent booster vaccination (9/13), cocooning strategy, i.e. vaccination of mothers and family member(s) of newborn infants (6/13), one-time adult pertussis booster vaccination (6/13), and decennial vaccination of adults with pertussis containing boosters (4/13). All studies found that booster vaccination was a cost-effective or cost-saving strategy compared to no booster vaccination. However, conclusions differed concerning the exact age groups to vaccinate and frequency of vaccination. Results were strongly affected by assumptions regarding unreported cases and uncertainty around incidence. Four models ignored herd immunity (HI) effects, 3 assumed incidence reduction attributable to HI, and 2 were transmission dynamic models predicting HI effects. Several studies considered incidence at steady state, although it was not reached before 80 years for some strategies. Methods used to compare multiple strategies were often inappropriate. CONCLUSIONS: Reviewed studies showed that pertussis booster vaccination is cost-effective or dominant vs. no booster vaccination, but did not identify any optimal vaccination schedule. Results are variable due to uncertainty surrounding disease incidence and extent of HI. Future economic evaluations should explore a wider range of strategies, according to local context.