BACKGROUND: In many low- and middle-income countries (LMICs), affordability is more important than cost-effectiveness as a gateway criterion for funding a new technology. Hence Budget Impact Analysis (BIA), in addition to cost-effectiveness analysis (CEA), is an essential decision-making component for policy-makers in the presence of limited resources. Despite this, BIAs remain less frequently conducted and less well researched than CEAs.  OBJECTIVES: To fill this gap by describing how budget impact considerations are captured within economic evaluations. METHODS: We develop and apply a quality assessment checklist based on the most recent recommendations from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force to examine the extent to which existing economic evaluations provide sufficient evidence about budget impact to enable decision-making. We use rotavirus vaccination as a case study because it represents a major investment that has been recommended by the World Health Organization and there exist many economic studies of it, yet it has seen only partial uptake in LMICs. A systematic review of the literature was conducted to identify economic evaluations of rotavirus vaccine conducted in LMICs. We critically appraised the quality of BIAs and assessed the extension of CEAs to provide useful budget impact information. RESULTS: Six BIAs and 56 CEAs were identified. All BIAs adhered to the majority of ISPOR recommendations. A small number of recommendations were not adhered to by most articles, including model validation, justification of program time horizon, and providing undiscounted financial streams. Most CEAs could not be extended to provide useful budget impact information. CEAs rarely presented annual costs undiscounted, or estimated financial streams of costs during the first few years of program scale-up. CONCLUSIONS: By highlighting current gaps in standard practices, we propose a comprehensive vaccine-specific strategy for conducting transparent and valuable BIAs alone or alongside CEAs.