OBJECTIVES:  Quadrivalent influenza vaccines (QIVs) contain one extra influenza B-lineage as compared with currently often used trivalent influenza vaccines (TIVs). This should overcome a reduced vaccine protection due to mismatches between TIV and the circulating B-lineage or due to co-circulation of both B-lineages. In this study we systematically reviewed the available literature on the cost-effectiveness of switching from TIV to QIV. METHODS:  The databases of Pubmed and Embase were searched in order to find economic evaluations of QIV versus TIV that were published before April 2016. RESULTS:  A total of ten studies were included, nine cost-utility analyses (CUAs) and one cost-comparison analysis. Two studies were using dynamic transmission models which are able to include herd effects, beyond vaccinated persons only. All CUAs concluded that, if adhering to national cost-effectiveness guidelines and applying nationally accepted cost-effectiveness thresholds, QIV would be a cost-effective intervention as compared with TIV. The cost-comparison study and one of the CUAs predicted that QIV would be cost-saving. Often reported parameters with high impact on cost-effectiveness outcomes included incremental vaccine price, degree of mismatch between TIV and the circulating B-lineage, and vaccine-induced cross-protection against the mismatched B-lineage. CONCLUSIONS:  Seasonal influenza vaccination with QIV seems to be a valuable intervention from an economic perspective. The use of dynamic models is advocated in order to estimate the full impact of QIV on influenza transmission, including herd effects. More understanding regarding cross-protection of TIV to the mismatched B-lineage and availability of data on disease outcomes and costs specified for influenza B would be desirable to further optimize the estimation of the cost-effectiveness of QIV.