OBJECTIVES: To assess the inclusion of cost and quality of life (QoL) impacts emerging from adverse events (AE) after administration of seasonal influenza vaccines in cost-effectiveness analysis. METHODS: A systematic literature review in PubMed and EMBASE was conducted to detect recent cost-effectiveness studies for seasonal influenza vaccines in the period 2008-2015. Only full-text articles published in peer-reviewed journals were included in our review. Mean outcome measures were inclusion of AE, and its related cost and QoL-impacts. RESULTS: Adhering to our search criteria, we included 48 studies. The number of studies that included AE was 24 out of 48 (50%), with AE present as: local AE, systematic AE, reactogenicity, medically significant wheezing, anaphylaxis and Guillain-Barré syndrome. Included AE-related outcomes contained probability of occurrence of AE (17 studies), duration of AE (5 studies), direct costs (18 studies), indirect costs (3 studies) and reductions in QoL (9 studies). Overall, studies including AE generally applied the societal or combined societal/third-part-payer perspectives. Furthermore, AE were predominantly taken into account in studies where trivalent inactivated influenza vaccines were compared with live-attenuated influenza vaccines. No articles discussing the recent issue of quadrivalent influenza vaccines vs. trivalent influenza vaccines included AE-related impacts. CONCLUSIONS: We found that half of the cost-effectiveness studies on seasonal influenza vaccination included the impact of AE. When AE were included, it mostly concerned direct costs, while indirect costs and QoL were scarcely included. Studies that used the societal perspective more often included AE as compared with studies only considering health care costs. Few studies including the whole spectrum of costs and effects of AE reported some moderate impact on cost-effectiveness. Finally, economic analyses that did not include costs and/or effects of AE generally commented that their occurrence is not influencing cost-effectiveness outcomes.