[Cost effectiveness of vaccinations: on the complexity of health economic analyses of influenza, SARS-CoV-2 and RSV vaccination].

The question of the cost effectiveness of medical interventions is one of the central issues in health economics. This narrative review examines the cost effectiveness of vaccination against influenza, SARS-CoV‑2 and respiratory syncytial virus (RSV) considering current health economic analyses. The annual influenza vaccination and the booster vaccination against SARS-CoV‑2 in 2023 and 2024 are proving to be cost effective and in some cases even cost saving, especially in high-risk groups. The cost effectiveness of the RSV vaccination, which was approved in 2023, is less clear. It strongly depends on the age group and the willingness to pay for a quality-adjusted life year (QALY) gained. The analysis shows that the evaluation of vaccinations requires a considerable amount of data. In addition to direct protective effects, model calculations on vaccinations must also consider indirect effects, such as the reduction of transmission in the population with higher vaccination rates. Sensitivity analyses make it clear that factors such as vaccine costs, effectiveness and disease incidence can have a decisive influence on cost effectiveness. One of the biggest challenges in health economic analyses is the fragmentation of health data in many countries, which makes comprehensive and precise assessments difficult. Initiatives such as the European Health Data Space could help and support evidence-based decision making in health policy. Overall, the cost effectiveness of vaccinations remains dependent on numerous factors, with SARS-CoV‑2 and influenza vaccinations receiving a positive assessment in the scenarios analysed.