OBJECTIVES: To examine the health and economic impact of PHiD-CV in the public sector of Hong Kong compared to no vaccination METHODS: A Markov analytical model modified from the recent Cost-effectiveness Cohort Model for Synflorix  (COSY Model by HE-group, GCRD, GSK bio, Wavre, Belgium, 2010) was used for the analysis of the outcomes of vaccination. The cohort model simulates in a birth cohort of 82,100 newborns the disease process of invasive disease (ID) (meningitis and bacteremia), community acquired pneumonia (CAP), and acute otitis media (AOM) over life-time caused by S pneumoniae and Non-typeable H influenzae (NTHi) within ‘monthly’ cycles. Superimposed on the disease process is integrated in the model its disease management expressed in hospitalization rates, medical visits, and specific interventions such as myringotomies. The epidemiology and disease management is Hong Kong specific. The study was performed from a health care payer’s perspective. RESULTS: The study shows for a 4-dose regimen of PHiD-CV compared to no vaccination over a period of 100 years: a gain of  234 quality-adjusted-life-years (QALY); an avoidance of 16 cases of IPD, 873 cases of pneumonia, 26,746 cases of AOM and 25,885 sequelae. Using a 5% discount for cost and benefits, cost/QALY gained was estimated to be HKD261,492. CONCLUSIONS: With GDP per capita of Hong Kong being HKD233,060 in 2009, our study results suggest PHiD-CV vaccination is cost-effective in providing protection to the people of Hong Kong based on the WHO recommended thresholds for cost-effectiveness.