Despite recommendations from the WHO to include herd immunity in vaccine economic evaluations in LMICs, less than one-fifth of published vaccine CEAs do so.

Including herd immunity effects in vaccine CEAs leads to more favorable CEA ratios.

In 42% of cases, including herd immunity in CEAs reduces ICERs enough to cross commonly cited LMIC cost-effectiveness benchmarks.

Vaccine value assessments should investigate cost-effectiveness with and without HI to inform decision-making in LMICs.