OBJECTIVES: Investigate the role economic evaluations played in supporting decision making for meningococcal C conjugate (MCC) vaccination. METHODS: We performed an extensive literature review (Pubmed, Embase, HEED, NEED) and contacted experts to identify a) the incidence of meningococcal C disease, and b) economic evaluations for MCC immunisation programmes and their influence on decision making. RESULTS: Data were obtained for Australia, Canada, Israel, the US and 17 European countries. The yearly meningococcal C incidence per 100,000 persons varied between 0.04 (Italy) and 4.91 (Iceland) in 2001. Ten countries have implemented MCC vaccination programmes. In all of them except Greece high meningococcal C incidence was reported between 1999 and 2001 (one year ≥ 0.8 per 100,000) but economic evaluations were performed in only four. While economic evaluation influenced decision making strongly in Australia, Canada (Quebec) and the Netherlands, its impact was limited in the UK. Of the 11 countries without MCC vaccination programmes, only Portugal and Switzerland conducted economic evaluations. These were performed after the initial decision to not implement MCC vaccination was made, but nonetheless (may) inform subsequent decision making in both countries. All reviewed economic evaluations were modelling studies, each showing that routine childhood MCC vaccination is slightly less effective but much more cost-effective early in the second year of life (about 2,500€ to 19,000€ per life-year or QALY gained) than during the first year of life (about 42,400€ to 2.4m€ per additionally gained life-year or QALY compared to immunisation in the second year). The reported results were most sensitive to meningococcal C incidence, vaccine price and specific methodological characteristics. CONCLUSIONS: Only in a minority of investigated countries economic evaluation of MCC vaccination influenced decision making. The divergence and importance of methodological characteristics in the analysed studies demonstrates the need of firmer international guidelines and better adherence to these guidelines.