Cost-effectiveness of routine annual influenza vaccination by age and risk status

•Cost-effectiveness of influenza vaccination varies by age and risk status.•Influenza vaccination is economically attractive for most age and risk groups.•Vaccination of healthy adults 18–49 years may exceed common cost-effectiveness thresholds.•Vaccination of higher risk groups are below common thresholds at low vaccine effectiveness.•Lower cost settings improve cost-effectiveness of influenza vaccination.