OBJECTIVES: To assess the cost-effectiveness of Palivizumab, a prevention against respiratory syncytial virus (RSV) in infants at high risk, such as premature babies, infants with bronchopulmonary dysplasia (BPD), and children with congenital heart disease (CHD) in an Austrian health care setting. METHODS: A decision tree model was used to estimate the cost-effectiveness of Palivizumab in high-risk children. The data sources included published literature, the Palivizumab pivotal trials, official price/tariff lists and national population statistics. The study was conducted from the perspective of the health care purchaser (HCP) (primary) and society (secondary). RESULTS: From the perspective of the HCP, the incremental cost-effectiveness ratio (ICER) for preterm infants is € 4,484/quality adjusted life year (QALY) without discounting; and becomes €14,439/QALY discounted. For children with BPD the ICER is €6719/QALY without discounting and increases to €21,672/QALY after discounting. In the CHD indication the ICER is €3,115/QALY undiscounted, while €11,390/QALY discounted. The results from the society perspective were substantially more cost-effective in all study populations. In preterm children the ICER is €1435/QALY without discounting, and becomes €4623/QALY discounted. For children with BPD the ICER is €4,881/QALY undiscounted and €15,741/QALY after discounting. For the CHD group the ICER is €251/QALY undiscounted, and €917/QALY discounted. Sensitivity analyses confirmed the robustness of the model. CONCLUSION: This study showed that Palivizumab is a cost-effective prevention against RSV infections in high-risk infants in Austria under the current health economic standards.