Evaluating the societal value of adult respiratory vaccination in Sweden: a benefit–cost analysis

BACKGROUND: In Sweden, older adults and adults in clinical risk groups are recommended vaccination against pneumococcal disease, respiratory syncytial virus, influenza, and COVID-19. However, vaccine uptake remains inadequate. This study estimates the socioeconomic benefits of these immunization programs under current coverage compared to aspirational scenarios, assessing the value foregone due to suboptimal uptake. RESEARCH DESIGN AND METHODS: We conducted a benefit-cost analysis from a societal perspective applying life table-based disease models to estimate benefit-cost ratios (BCRs) and net benefits (NBs). Health impacts were monetized through the value-of-a-statistical-life and cost-of-illness approaches. Costs comprised vaccination program expenses. Scenario and sensitivity analyses explore coverage and program eligibility. RESULTS: Vaccination programs in older adults generated BCRs of 3:1 and NBs of SEK 54.4 billion over a lifetime (VSLY). When risk groups were included to model current strategies in Sweden, NBs increased to SEK 59.7 billion. Reaching aspirational coverage targets increased NBs by 18%, meanwhile restricting eligibility reduced NBs by 64%. CONCLUSION: Adult respiratory vaccinations in Sweden provide substantial value for the healthcare system, economy and society, with estimated benefits exceeding costs under modeled assumptions. These findings may inform policy discussions on strategies to sustain or expand vaccination budget, improve access and increase uptake, particularly among at-risk populations.