OBJECTIVES: A novel intradermal vaccine (ID) containing 15µg of haemagglutinin per dose was specifically developed to prevent seasonal influenza in subjects aged 60 years and over (60+). In this population, superior immunogenicity of ID vaccine to conventional intramuscular vaccine (IM) has been demonstrated during clinical trials. We assessed the clinical outcomes and economic impact of vaccinating 60+ with ID versus IM vaccines.  METHODS: A decision-analytic model compared the cost-effectiveness ratios of ID versus IM vaccines. Epidemiological and economic inputs were specific to Slovakia and Czech Republic, whereas vaccine effectiveness rates were estimated from international literature and inferred from clinical trials. ID prices were hypothetical. Results were reported according to public payer’s perspective. RESULTS: In Slovakia, ID vaccination was found to prevent 13,134 influenza cases, 1,159 hospitalizations and 273 deaths in the 60+ population, more than with IM vaccination (respectively 11,235 influenza cases, 991 hospitalizations, 234 deaths). In Czech Republic these figures were respectively 35,691, 3,642 and 584 with ID versus 30,532, 3,115 and 500 with IM. Higher price of ID versus IM was partially offset by the costs saved thanks to disease avoided: an incremental €5 per subject vaccinated with ID in Slovakia and €4.4 (CZK118.10) in Czech Republic was required from the payer’s perspective. Incremental cost-effectiveness ratios of ID versus IM were €12,852/QALY in Slovakia and €10,375/QALY (i.e. CZK278,532/QALY) in Czech Republic. These values were below three yearly GDP per capita in these 2 countries and therefore could be seen as acceptable for health authorities. In probabilistic sensitivity analyses, ID vaccination remained a cost-effective strategy. CONCLUSIONS: In the absence of published local guidelines regarding the interpretation of cost-effectiveness ratios, we chose to follow WHO guidelines regarding GDP per capita: immunizing the 60+ population with ID in Slovakia and Czech Republic appears as a cost-effective alternative when compared to IM.