Aim:Estimate incidence and costs of cardiac device infections (CDIs) in Germany. Materials & methods:Patients had an implantable cardioverter defibrillator implanted over 2010–2013 and were followed to December 2014 using German health insurance claims data. A case-controlled analysis was performed using propensity score matching methods. Results:Risk of CDI 12 months post-implant was 3.4 overall, either 2.9 for de novoprocedures versus 4.4 for replacement procedures. Mean 3-year incremental expenditure per patient for patients with CDI compared with controls was €31,493 for de novoimplant patients and €33,777 for replacement patients. Mean incremental expenditure was €59,419 per patient with a major infection. Conclusion:CDIs are highly expensive to manage, reinforcing the need for strategies to reduce their occurrence.