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

This study aims to systematically review the published economic evaluations of vaccines included in China’s National Immunization Program (NIP), synthesise the current evidence base, and assess their cost-effectiveness. A comprehensive search was conducted across PubMed, Web of Science, Embase, CNKI, CSTJ, and Wanfang Data for cost-benefit analyses (CBA), cost-effectiveness analyses (CEA), and cost-utility analyses (CUA) related to NIP vaccines in China, from database inception to 14 July 2025. Studies were screened following the PRISMA guidelines. The study’s reporting quality was assessed using the CHEERS 2022 checklist, while methodological quality was evaluated using the QHES instrument. A total of 41 studies were included and demonstrated an overall moderate methodological quality (mean CHEERS score: 66.42; mean QHES score: 70.63). The included studies covered a range of NIP-targeted vaccines, including hepatitis B, measles, tuberculosis, diphtheria-pertussis-tetanus, hepatitis A, and meningococcal vaccines, with hepatitis B receiving the greatest research focus (n = 32). Most evaluations were conducted from a societal or healthcare system perspective. The majority of studies reported benefit-cost ratios (BCR) greater than 1 or incremental cost-effectiveness ratios (ICER) below the per capita GDP threshold, indicating substantial economic value. Despite variations in model structures, baseline parameters, and assumptions, all studies consistently concluded that NIP vaccines are cost-effective compared with no vaccination. Hepatitis B vaccination, particularly when combined with maternal transmission prevention strategies, demonstrated exceptionally high net benefits at both national and subnational levels. NIP vaccines in China offer substantial economic value; however, interpretation of the findings may be influenced by methodological heterogeneity and the use of GDP per capita-based cost-effectiveness thresholds, and the adoption of standardised evaluation methods is essential to support policy optimisation and sustainability.