Economic evaluation of national immunization program vaccines in China: a systematic review

This systematic review, published in Health Economics Review, synthesises evidence on the economic evaluation of vaccines included in China’s National Immunization Program (NIP). The study systematically reviewed cost-effectiveness, cost–benefit, and cost–utility analyses of NIP vaccines using PRISMA guidelines and assessed study quality using CHEERS 2022 and QHES tools. The review analyses 41 studies to evaluate the economic value of immunization and assess methodological quality and consistency across the evidence base.

Key findings

• All included studies consistently found that vaccines in China’s NIP are cost-effective compared to no vaccination, with many reporting benefit–cost ratios greater than 1 or ICERs below GDP-based thresholds.
• Hepatitis B vaccination is the most extensively studied and demonstrates particularly high economic returns, especially when combined with prevention of mother-to-child transmission strategies.
• Other vaccines—including measles, BCG, DTP, hepatitis A, meningococcal, and Japanese encephalitis—also show strong economic value across multiple settings.
• Economic outcomes are influenced by vaccine type, target population, delivery strategies, financing mechanisms, and baseline coverage levels.
• The overall methodological quality of studies was moderate, with variability in reporting and analytical approaches.
• Substantial methodological heterogeneity (e.g., perspectives, discount rates, models, and thresholds) limits comparability across studies.
• The widespread use of GDP per capita–based thresholds may not accurately reflect opportunity costs in resource allocation decisions.
• There is a need for more standardized and transparent economic evaluation methods to support policy decision-making and program sustainability.

Thumbnail Photo by Margo Evardson on Unsplash