Background: Immunization decision-making (IDM) is usually based on multiple sources of evidence. Health economics (HE) has become increasingly relevant in IDM as one aspect to be considered. Objective of this study was to generate a consensus among stakeholders on how to implement HE into IDM in Germany. Method: We conducted a systematic literature review in order to identify relevant methods and advantages of considering HE evidence in IDM. Furthermore, an overview of IDM in several European countries was compiled based on literature. The generated evidence was used to prepare a national stakeholder symposium in January 2015 on which representatives from academia, politics, industry, administration and patient-support groups were able to discuss different options on how to implement HE into IDM. Results: Based on the literature review five core advantages from considering HE aspects in IDM were identified: (I) modelling of future vaccine related public health effects; (II) identification of the most efficient vaccination strategy; (III) identification of critical input parameter; (IV) budget-impact-analysis; and (V) decision-making based on an incremental cost-effectiveness threshold. A recently conducted survey showed that most European countries consider HE in IDM. This is done (a) most frequently via an informal appraisal, (b) rarely by using a cost-effectiveness threshold (4 countries), and (c) never by applying multiple-criteria decision-analyses. After key-note lectures, group-works and panel discussions, the majority of stakeholders had the opinion that in Germany the core advantages of (I) to (III) should be taken into account and decisions should be derived from an informal appraisal. Discussion: Most of the invited stakeholders acknowledged the use of HE in IDM. There was consensus that in Germany a cost-effectiveness threshold is no option. However, HE might be considered in IDM to compare different vaccination strategies and highlight the potential (economic) benefits of vaccination.