OBJECTIVES: To analyze the cost-effectiveness of mass primovaccination of newborns in the Slovak Republic with BCG vaccine against tuberculosis compared to the cost-effectiveness of selective primovaccination of specific groups, as well as to there being no vaccination at all. METHODS: To compare cost-effectiveness, methods were chosen as to determine direct cost of illness and minimization of costs from the perspective of health insurance companies. Additionally, the closely related parameter of direct costs needed to prevent one case of active tuberculosis in children aged 0 to 14 years was analyzed. The own adapted model was used. RESULTS: Data used were obtained from the Public Health Authority of the Slovak Republic, National Tuberculosis Registry, State Institute for Drug Control, Statistical Office of the Slovak Republic, Ministry of Health, and from Health Insurance Companies. We assumed that the vaccine will have a 15-year effect, at an average effectiveness of 63.3% in preventing active tuberculosis. The costs for preventing one case of active tuberculosis in children aged 0 to 14 years would be € 794.69 lower if mass vaccination of newborns is applied than if all vaccination was to be discontinued. For selective vaccination of newborns, the cost of preventing one case of active tuberculosis in children aged 0 to 14 years would be € 440.02 lower than if all vaccination were to be discontinued.  Finally, mass vaccination of newborns results in the cost of preventing one case of active tuberculosis in children aged 0 to 14 years being  € 1 731.75 lower than for selective vaccination. CONCLUSIONS: The most advantageous strategy for the state would be to implement mass vaccination of newborns against tuberculosis. A shift to selective vaccination would only be beneficial if the costs for treatment of tuberculosis were to decrease dramatically. The least useful strategy would be to discontinue vaccination.