OBJECTIVE: Increasing antibiotic resistant staphylococcus aureus strains in hospital- and chronic disease patients causing a high burden of illness and consume enormous health care resources in Germany. A new vaccine (StapVax) preventing S.aureus infections is in clinical development and currently seeking market authorization in the EU. The objective of this analysis is to project the potential economic value of vaccinating hemodialysis patients with StapVax against mecillin resistant staphylococcus aureus infections. METHODS: A literature-based decision analysis model was developed to assess the annual number of potential infections and death avoided as well as to calculate cost-effectiveness, break-even price and budget impact of the candidate vaccine. Baseline efficacy rate was assumed to be 57% with a 90% coverage rate. The model compared projected cost per infection avoided and cost per life-year gained for patients receiving the vaccine versus unvaccinated patients undergoing hemodialysis. RESULTS: Vaccinating the about 60,000 hemodialysis patients in Germany could prevent 650 S.aureus infections and 105 associated deaths per year. Assuming annual per patient vaccination cost of €500 (vaccine plus administration) the cost per infection avoided was estimated at €27,000, with a cost per life-year gained of €17,000, respectively. The net-budget impact in this scenario results in about €18 million. Vaccination cost of €170 would make the vaccine a budget neutral preventive strategy. Monte Carlo simulations on vaccine efficacy, mortality rate after S.aureus infection, treatment and vaccination cost resulted in cost per life-year gained ranging from €3000 to €22,000 in 95% of the runs, and from €7000 to €14,000 in 50% of trial runs. The model is most sensitive to vaccine program cost and predicted preventive efficacy. CONCLUSION: Vaccinating hemodialysis patients with StaphVax is a highly cost-effective measure to prevent serious morbidity and mortality in this patient population at substantial risk of bacterial contamination.