OBJECTIVES: Rotavirus gastroenteritis (RVGE) is one of the most frequent diseases among children aged 5 or younger. A general recommendation for rotavirus vaccination in Germany does not exist so far, leading to a vaccination rate of < 30%. This analysis simulates the cost-effectiveness of a general rotavirus vaccination in Germany using RotarixTM from the perspective of the statutory health insurance (SHI). METHODS: An existing Markov model on rotavirus infection in children (published before) was adapted to the German situation. The model simulates costs and effects of rotavirus vaccination in a birth cohort of 699,301 children. In the model, vaccine efficacy rates from international clinical trials were combined with German epidemiology and cost data from the SHI perspective for 2011 (including SHI reimbursed productivity losses of parents). The model assumes a vaccination rate of 100% and discount rates of 3% for costs and effects. Results were tested for robustness using sensitivity analyses. RESULTS: A 100% vaccination with RotarixTM could avoid approximately 156,000 RVGE cases and associated physician visits as well as in-patient hospital stays. From the SHI perspective, this leads to cost savings of 13.6 Mio € in total. The main factors responsible for these savings are in-patient hospital stays avoided (64.1 Mio €), SHI reimbursed productivity losses of parents (19.0 Mio €) and physician visits avoided (5.4 Mio €). On the other hand, vaccination costs amount to additional 79.4 Mio €. Stability of results was most sensitive with respect to epidemiological parameters (number of RVGE cases, in-patient hospital cases) as well as productivity loss. CONCLUSIONS: A general vaccination against rotavirus in Germany can avoid severe diarrhea events in children aged 5 and younger. Additional vaccination costs for the SHI are more than outbalanced by cost savings through in-patient hospital stays, SHI reimbursed productivity loss and physician visits avoided.