OBJECTIVES: Although influenza affects all age groups, influenza is common in children.  Between 15% and 42% of preschool and school-aged children experience influenza each season.  Recently, LAIV has been approved in Canada for use in eligible persons aged 2-59 years of age. The study objectives were to determine the cost-effectiveness of LAIV compared to TIV in Canadian children and adolescents from a Ministry of Health (MoH) perspective and a societal perspective. METHODS: A previously published US cost-effectiveness model using patient-level data to compare LAIV and TIV was supplemented by secondary (e.g. literature) and primary data (i.e. survey of 144 Canadian physicians). To compare the costs and benefits of LAIV and TIV, a cost-utility analysis was conducted. Parameter uncertainty was addressed through probability sensitivity analysis (PSA). RESULTS: Although LAIV increased vaccination costs compared to TIV, LAIV reduced the number of influenza illness cases and lowered the number of hospitalizations, ER visits, outpatient visits and parents’ days lost from work. The estimated offsets in direct costs saved were $4.19 per vaccinated child aged 2-17 years. Societal savings were $35.33 per vaccinated child. When costs and outcomes were considered, LAIV was the dominant strategy when compared to TIV. At a willingness to pay of $50,000 per QALY gained, the results of the PSA indicated that the probability of LAIV being cost-effective was almost 1. CONCLUSIONS: LAIV reduces the burden of influenza in children and adolescents. Consistent with US results, vaccinating children with LAIV instead of TIV is the dominant strategy from a societal and MoH perspective.