BACKGROUND: Ventilator-associated pneumonia (VAP) places a substantial financial strain on both individuals and the healthcare system. There is ample evidence supporting the clinical utilization of different endotracheal tube (ETT) modifications to reduce the occurrence of VAP. However, there has been a lack of comprehensive assessment for their cost-effectiveness. This systematic review aims to thoroughly assess health economic studies that specifically examine the use of various modifications of ETTs in preventing VAP. METHODS: An extensive search was conducted across 5 medical databases to find all full economic evaluations conducted between January 2010 and December 2023. The assessment of the studies' quality was conducted using the updated Consolidated Health Economic Evaluation Reporting Standards statement. RESULTS: A total of 4 economic assessments were identified, comprising of 3 studies of good quality and 1 study of medium quality, carried out in 3 different nations. The studies employed the Venner-PneuX (VPX) system ETT, the ETTs with heat and moisture exchangers filter, and the subglottic suction ETT. The comparator group consisted of either a standard ETT in 3 studies or multiple preventative strategies in 1 study. All 4 studies shown that the utilization of modified endotracheal ETTs holds significant promise in reducing the incidence of VAP from both a societal and hospital perspective. In particular, the utilization of ETT subglottic suctions was determined to be cost-effective in 2 studies. CONCLUSION: The use of modified ETT could result in improved patient outcomes and more efficiency in utilizing healthcare resources. Nevertheless, the result remains tentative due to the limited number of studies included and the heterogeneity in their methodology. Henceforth, it is important to carry out more extensive economic assessments by utilizing larger and more representative sample sizes.