OBJECTIVES: In 2011, intranasal administrated live-attenuated influenza vaccine (LAIV) for prophylaxis of seasonal influenza was approved in the EU for children aged 2-17 years. Our objective was to estimate the potential epidemiological impact and cost-effectiveness of the current policy to vaccinate people over 60 years and people with underlying chronic conditions with trivalent inactivated vaccine (TIV) compared to the addition of routine childhood vaccination with LAIV in Germany. METHODS: A compartmental susceptible-exposed-infectious-recovered-susceptible (SEIRS) model populated with German specific data was developed to explore the impact of vaccination on the transmission dynamics of seasonal influenza. In addition, a decision tree was constructed to incorporate several consequences of influenza infections and to compare costs and outcomes of different vaccination strategies in the German health care setting. The time horizon was set to ten years after the introduction of LAIV, assuming childhood vaccination coverage of 70%. Input data were based on published literature or were derived by expert consulting using the Delphi technique. RESULTS: Under base-case assumptions, annual routine vaccination of children would prevent 8.8 million influenza illnesses, resulting in a reduction of 273,124 cases of acute otitis media and 68,102 cases of community-acquired pneumonia over ten years if left undiscounted. The discounted incremental cost-effectiveness ratio was €9601 per QALY gained from a third-party payer perspective, when compared to the current strategy of vaccinating only risk groups with TIV. Inclusion of patient co-payments and indirect costs resulted in a discounted 10-year cost-saving to society of €1.16 billion. CONCLUSIONS: Compared with the current vaccination policy, introducing childhood and adolescent vaccination with LAIV can substantially increase benefits and reduce overall costs when adopting a societal perspective. Using the commonly cited threshold of €50,000 per QALY gained, routine vaccination of children with LAIV can be considered cost-effective from a third-party payer perspective.