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

Background/Objectives: Middle-income countries (MICs) in the Middle East and North Africa (MENA) face financial and health system barriers when introducing new vaccines. The Gavi MICs approach has supported the introduction of pneumococcal conjugate (PCV), human papillomavirus (HPV), and rotavirus (RV) vaccines; however, economic evidence from the region remains limited. This systematic review assessed the quantity, characteristics, and quality of economic evaluations of these vaccines in MENA MICs published between 2015 and 2025 and synthesised economic evidence to inform policy decisions in Algeria, Egypt, Iran, Jordan, Lebanon, Morocco, Palestine, and Tunisia. Methods: Relevant databases and registries were searched for cost–effectiveness, cost–utility, cost–benefit, and budget impact analyses of PCV, HPV, and RV vaccination strategies. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Results: Twenty-six studies met the inclusion criteria, including 12 on HPV, nine on RV, and five on PCV. Vaccine introduction was the most commonly evaluated intervention (n = 23), and most studies were cost–effectiveness or cost–utility analyses adopting payer, health system, societal, or mixed perspectives. PCV and RV introduction were consistently found to be cost-effective or cost-saving. HPV introduction showed mixed results, particularly in Iran, but was generally cost-effective in Tunisia and Morocco. Reporting of vaccine coverage, delivery costs, and programmatic constraints was limited, and overall methodological quality varied. Conclusions: Available evidence supports the economic value of PCV and RV introduction in MENA MICs, while HPV’s cost-effectiveness is context dependent. Future evaluations should incorporate dynamic modelling, implementation costs, and affordability considerations to better inform sustainable vaccine introduction.