Three economic evaluations of pandemic influenza A (H1N1) vaccination campaigns in North America concluded that the mass vaccination campaigns would be, or were, highly cost-effective, if not cost-saving. This paper re-assesses each study’s analysis and presents three arguments: 1) prediction of vaccine program cost-effectiveness is unrealistic, if not impossible, unless quality surveillance data is available; 2) even when surveillance data is available, vaccine cost-effectiveness calculations can still vary dramatically and need to undergo wider-ranging sensitivity analysis; 3) H1N1 vaccination campaigns in North America were likely not as cost-effective as previously thought. Several recommendations are then made for improving transparency, accuracy, portability, and sensitivity analysis in pharmacoeconomic studies more generally.