Contributions of cost-effectiveness analyses (CEA) to influenza vaccination policy for older adults in Europe

•Individuals ≥65 years of age are at increased risk of severe influenza outcomes.•Enhanced influenza vaccines are often recommended for older adult populations.•Countries may wish to select between enhanced vaccine options, but no head-to-head efficacy data are available.•Cost-effectiveness analysis is considered crucial to vaccine assessment among certain countries in Europe.•Real-world evidence (RWE) is an important evidence source to input into cost-effectiveness analysis models.•Further harmonization of economic evaluations with increased use of RWE, may support influenza vaccine recommendations.