Socioeconomic value of adult respiratory vaccination in the United States: a benefit-cost analysis.

Background: Respiratory infections, including pneumococcal disease (PD), respiratory syncytial virus (RSV), influenza, and COVID-19, impose substantial health and economic burdens on adults in the United States. Although vaccines are available, coverage remains suboptimal. Methods: We conducted a societal-perspective benefit-cost analysis of adult PD, RSV, influenza, and COVID-19 vaccination programs. Four disease models estimated averted morbidity, mortality, and productivity losses. We evaluated current CDC recommendations and scenarios of varying eligibility and coverage. A complementary analysis estimated the net present value of 1 year's vaccination activity. Results: Under current age-based recommendations, vaccination prevents over 182 000 deaths and 2.5 million hospitalizations within 15 years. Society values these outcomes at 5-12 times the cost of delivering the programs. Including at-risk adults averts an additional 13 600 deaths. Restricting eligibility or coverage could increase vaccine-preventable hospitalizations by over 1 million, increasing healthcare costs by almost $50 billion; expanding eligibility and increasing coverage to 75% substantially improves societal welfare and could additionally avert over 100 000 deaths. One year's vaccination activity prevents ∼300 000 hospitalizations, and ∼18 500 deaths, generating $6-$12 in societal value per $1 spent. Conclusions: Adult respiratory vaccination programs generate considerable societal returns. Increasing coverage and sustaining clear, evidence-based recommendations can unlock further health and economic gains.