ObjectiveTo determinewhether influenza vaccination in the elderly is cost effective or cost saving compared with a non-intervention strategy andwhether it is worth framing a vaccination policy for this population.BackgroundInfluenza causes substantial morbidity and mortality in elderly people. Despite the availability of effective vaccines against this disease, vaccine coverage in the elderly is low in many countries. Evaluations of the economic impact of influenza vaccination can support public health policy decisions concerning vaccination and also may help influence changes in practice behaviour.MethodsWe performed a literature review of cost-benefit and cost-effectiveness evaluations of influenza vaccination in the elderly. We provide a summary of the principal findings from 11 economic evaluations of influenza immunisation and discuss their effect on policy decisions for vaccination in the elderly population.ResultsThe cost-benefit and cost-effectiveness results in elderly individuals, derived from 7 model-based simulations, 3 observational analyses and a case-control study, all support the recommendations for vaccination of all persons of 65 years and over that are currently endorsed in the US, Australia, New Zealand and many European countries. All evaluations showed that influenza immunisation was cost effective or would result in cost savings compared with a no-vaccination strategy.ConclusionsAlthough clinical and economic data indicate the benefit of influenza vaccination in the elderly, the vaccine coverage rate in many countries is disappointing, even when vaccine is provided free of charge. It is clear that strategies aimed at the patient or healthcare provider are needed to increase implementation of a vaccination policy to ensure that any recommended vaccine programme is clinically and economically effective.