OBJECTIVES Endobronchial valve therapy (EBV) is an innovative treatment that has been shown to be safe and effective in selected subgroups of patients with severe emphysema. The objective of our study was to assess the cost-effectiveness of valve treatment in the German healthcare system when compared to medical management. METHODS Clinical data from a subset of the Endobronchial Valve for Emphysema Palliation Trial (VENT) provided information about clinical events, health-related quality of life, and disease staging through 12 months. This information was subsequently used as input to a previously published Markov model to project longer-term disease progression, mortality, and health resource utilization. From this combined analysis, we computed the 5-year and 10-year incremental cost-effectiveness ratio (ICER) in euros per quality-adjusted life year (QALY). Costs and effects were discounted at 3% per year. RESULTS EBV therapy led to clinically meaningful disease restaging at 12 months (37.8% of cohort improved staging, compared to 0% in control). Over 5 years, EBV was projected to increase survival from 66.4% to 70.7%, and to add 0.22 QALYs. Costs were estimated to increase by € 10,299, resulting in an ICER of €46,322/QALY. Over 10 years, 0.41 QALYs were gained at additional cost of €10,425, yielding an ICER of €25,142/QALY. CONCLUSIONS Our model-based analysis suggests that EBV leads to clinically meaningful changes in disease staging and progression when compared to medical management, with resulting gains in unadjusted and quality-adjusted life expectancy. Relative to the acknowledged willingness-to-pay threshold of € 50,000/QALY, our results indicate EBV is a cost-effective therapy in the German healthcare system.