OBJECTIVES: To estimate the cost and mortality impact of stockpiling pre-pandemic influenza vaccine for Germany, from a societal perspective. METHODS: A static decision analytic model was developed to examine the balance between stockpiling costs and potential cost-savings on primary care, medication, hospitalization and productivity losses and to assess the number of prevented deaths. The applied time horizon was five years. In the base-case, the annual probability of a pandemic, the clinical attack rate and case fatality rate in patients not receiving any anti-viral medication were conservatively estimated at 3%, 30% and 1%, respectively. The vaccine efficacy was assumed to be 65%. The effect of anti-viral medication on costs and mortality was considered. Stockpiling costs included acquisition, storage, expected replacement and expected administration costs of the vaccine. Productivity costs were estimated using the human capital approach. All costs were expressed in €2008. Costs but not deaths were discounted at 5% per year. Extensive univariate and probabilistic sensitivity analyses were performed. RESULTS: Stockpiling of pre-pandemic influenza vaccine was predicted to cost €1.54 billion and avoid €7.48 billion direct and productivity costs thus rendering net savings of €5.94 billion, (95% CI: €53 million; €16.3 billion). In addition, 17,711 deaths could be avoided. The probability of stockpiling vaccine being cost-saving was estimated at 97.7%. The most influential model parameters were the annual risk of a pandemic, followed by the case fatality rate. These results are likely to be conservative as herd immunity and macroeconomic effects were not included. CONCLUSIONS: Stockpiling of pre-pandemic vaccine can be considered a dominant strategy for Germany as it is predicted to lead to cost-savings and to avoid a considerable number of deaths.