OBJECTIVES: To estimate the cost-effectiveness of atomoxetine, a non-stimulant alternative for the treatment of children with ADHD, compared to currently used stimulant therapies in Germany. METHODS: The economic analysis employs a Markov process to estimate the incremental cost per QALY gained by the introduction of atomoxetine compared to prevailing treatment options in Germany including extended release methylphenidate (XR-MPH) and immediate release methylphenidate (IR-MPH). The economic model is calculated for three discrete patient populations; stimulant-naïve patients, stimulant-failure patients and patients with unmanageable contra-indicated comorbid conditions. Utility values were derived from a survey of 83 parents of children with ADHD. The effectiveness and safety aspects of the various treatment options, based on a thorough review of controlled clinical trials and other clinical literature, were validated by clinical experts. Cost values were estimated from the perspective of the German health service. Expected cost and outcome values were calculated over one year. RESULTS: In the stimulant-naïve population, the ICER of atomoxetine was estimated at €18,227 per QALY gained compared with IR-MPH, and €7,778 per QALY gained compared with XR-MPH. In the stimulant-failure population, the ICER of atomoxetine was estimated at €14,385 per QALY gained compared with no medication. In the stimulant contra-indicated population, the ICER of atomoxetine was estimated at €14,916 per QALY gained compared with no medication. Sensitivity analyses showed that the results of the model were robust to changes in most important variables with the utility values being important indicators of the cost-effectiveness of atomoxetine. CONCLUSION: The incremental cost per QALY gained of atomoxetine compared to current treatment options suggests that atomoxetine offers a value-for-money alternative in the treatment of children with ADHD in Germany.