Economic Evaluations of New Vaccine Introduction in Middle-Income Countries in the Middle East and North Africa Region: A Systematic Review

This peer-reviewed systematic review in Vaccines examines economic evaluations of pneumococcal conjugate vaccines, HPV vaccines, and rotavirus vaccines in Gavi MICs-eligible middle-income countries in the Middle East and North Africa. The review synthesizes cost-effectiveness, cost-utility, cost-benefit, and budget impact studies published between 2015 and 2025 for Algeria, Egypt, Iran, Jordan, Lebanon, Morocco, Palestine, and Tunisia. It assesses the quantity, characteristics, and methodological quality of available evidence to inform policy decisions on new vaccine introduction and sustainable financing.

Key findings

• Twenty-six studies were included: 12 on HPV, 9 on rotavirus, and 5 on pneumococcal conjugate vaccines.
• PCV and rotavirus vaccine introduction were consistently found to be cost-effective or cost-saving across reviewed settings.
• HPV vaccination findings were more context-dependent, with mixed results in Iran but generally favorable results in Tunisia and Morocco.
• Vaccine price, achievable coverage, disease burden assumptions, and analytic perspective were key drivers of cost-effectiveness results.
• Many studies provided limited information on delivery costs, wastage, baseline coverage, budget impact, affordability, and implementation constraints.

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