The strategy toward influenza vaccination is currently on individual-initiated basis in Japanese school. Although our former analysis on the issue suggested mandatory vaccination in Japanese school has substantial cost savings, there still exist controversies on the alternatives for the vaccination. OBJECTIVE: Using multivariate analysis with the Monte Carlo simulation, we evaluate cost-consequences of the controversial strategies for influenza vaccination to compare with no vaccination for healthy school-aged children in Japan. METHOD:  A cost-consequence analysis was performed by decision analytic modeling using data from the literature. The decision tree was employed to make a healthy school-aged child facing the alternatives toward influenza: 1) individual-initiated voluntary vaccination; 2) mandatory vaccination in school; or 3) no vaccination. Direct costs such as medical cost for vaccination, physician visits, and treatments were taken into account including indirect costs as lost productivity of the parents burdened by taking care of their children. The multivariate analysis in use of the Monte Carlo simulation was performed to compare the total cost of each scenario with that of no vaccination consequence. RESULTS: Considering two covariates, i.e., vaccination effect and prevalence of influenza, the analysis was able to make us reconfirm the similar conclusion as the suggestion in the past study that the total cost of mandatory scenario had a marginal saving of US$50 (JY6000) comparing with the voluntary one. The results were quite robust towards multi-way sensitivity analysis in the computer simulation. CONCLUSION: Mandatory policy for influenza vaccination for school-aged children is favorable with substantial cost savings in the societal perspective of Japan.