BACKGROUND:
Pneumococcal conjugate vaccines (PCVs) remain central to preventing pneumonia and invasive pneumococcal disease, yet their cost-effectiveness varies across epidemiological settings, vaccine formulations, and financing transitions. This systematic review synthesizes African modelling evidence on the economic value of PCVs across diverse delivery scenarios.

METHODS:
We systematically searched PubMed, Embase and HTA databases for full economic evaluations of PCV10 or PCV13. The search was conducted in October 2025, limited to English-language studies, with no restrictions on publication year. Study quality was assessed using the CHEERS 2022 checklist. A narrative synthesis was used due to heterogeneity in modelling approaches and cost metrics.

RESULTS:
Of 790 records screened, seventeen studies met predefined inclusion criteria. Most studies were of moderate to high methodological quality. PCV13 and PCV10 consistently reduced childhood pneumonia, meningitis, and invasive pneumococcal disease. National models reported between 1,000 and 15,500 deaths averted over 10 years, whereas humanitarian region analyses showed 56 deaths and 3,600 pneumonia cases averted per 100,000 vaccinated. PCV13 achieved ICERs between US$40–US$240 per DALY averted in most low- and middle-income settings, and remained cost-effective post-Gavi transition with ICERs around US$500–US$600 per DALY. In head-to-head evaluations, PCV13 was more cost-effective than PCV10 in regions with high serotype 19A prevalence. Key determinants of cost-effectiveness included vaccine price, pneumonia incidence, case fatality rates, and serotype distribution.

CONCLUSIONS:
Evidence from diverse global settings shows that PCVs deliver large health gains and remain highly cost-effective under a wide range of epidemiological, economic, and financing conditions. Prioritizing affordable vaccine pricing will further enhance the economic impact of PCV programmes.