OBJECTIVES: To review evidence on cost-effectiveness of screening and vaccination programs currently funded in Italy, in order to develop a tool to appraise the efficiency of healthcare expenditure on prevention. METHODS: Cost-utility studies carried out in Italy between 1995 and 2014 where gathered though PubMed search engine. The following inclusion criteria were applied to the records retrieved: (i) Cost-Utility analysis; (ii) Italian setting; (iii) National Health Service Perspective; (iv) lifetime horizon; (v) intervention belonging to one of these clinical area: viral hepatitis, cancers, metabolic and cardiovascular diseases; infectious or respiratory disease. Prevention programs have been ordered in league tables. Mean and standard deviation of incremental values and ICERs reported in the selected studies were utilized to simulate a Cost-Effectiveness Acceptability Curve of each clinical area and type of intervention i.e. screening or vaccination program. RESULTS: The cost-effectiveness function of prevention programs yield an ICER < € 30.000/QALY in 80% of realizations. Vaccines are the most efficient interventions, since they exhibit an ICER lower than treatments of the same clinical in more than 90% of simulations CONCLUSIONS: Prevention programs typically require immediate investments yielding future health benefits. To acknowledge this peculiarity means to adopt not only a short (Vaccinations against influenza , chicken pox , measles), but also a medium (vaccination against zoster, genital warts , and tetanus) and long time horizon (screening of cancers and hepatitis) when assessing the efficiency of healthcare programs. Failure to reach the threshold of 5 % of spending on prevention required by Italian national healthcare planning, is therefore to be understood as a form of rationing, rather than rationalization of healthcare resources.