OBJECTIVES: To assess the costs and the health-related quality of life (HrQoL) of patients with Gilles de la Tourette's syndrome (GTS) in Germany METHODS: Direct and indirect costs as well as HrQoL were evaluated in 200 patients with GTS in three outpatient departments in Germany. Economic data was provided in a patient diary over a three-months-period. Costs were analyzed from the perspective of the statutory health insurance. Indirect costs were calculated by the human capital approach. HrQoL was measured using the EuroQol instrument. Depression was assessed using the Beck Depression Inventory (BDI) and clinical symptoms with the Yale Tourette Syndrome Symptom list (YTSSL) and the Shapiro-Tourette-Syndrome-Severity-Scale (STSSS). RESULTS: Direct costs amounted to €635 during the evaluation period. Indirect costs totalled to €2500. Major cost components were: drug costs (€350) and in-stays (€300). Patients with GTS proved to have a worse HrQoL than a representative sample of the general German population. In GTS patients the most affected EQ-5D domains were anxiety/depression (57.1%), pain/discomfort (47.5%), and daily activities (38.4%). The mean EQ VAS score was 65.4±21.9. The patients had a mean BDI score of 12.3±9.9, which was considerably worse compared to a representative German sample with a mean BDI score of 6.45±5.2. The mean STSSS value was 3.24±1.1. There was no significant difference between genders with respect to tic severity. A significant correlation for BDI, age, YTSSL, STSSS, subjective efficacy of drug treatment, occupational advancement, current work status, and direct cost was detected in univariate analyses. CONCLUSIONS: To our best knowledge this is the first observational study on the burden of GTS in Germany. With annual total costs of about €12,500, GTS places a notable financial burden on society. HrQoL is considerably reduced in patients with GTS. While tic treatment is important, co-morbidities such as depression should be regarded more seriously.