OBJECTIVES: . In 2010, there were more than 1500 illness related to Streptococcus pneumonia infections in pediatric population under 2 years old in Panamá. Currently, in Panamá, Prevenar 7 is the anti-pneumococcal vaccine (PCV) used. The aim of this study was to estimate the cost-effectiveness and cost-utility of immunization strategies based on pneumococcal conjugated vaccines (PCVs) in Panamá, from an institutional perspective. METHODS: . A decision tree steady state model was used to assess the population level public health and economic impact of infant anti-pneumococcal vaccination. The alternatives compared were: no vaccination (comparator), PCV-7, PCV-10 and PCV-13. The effectiveness measures were: child illness avoided, life years gained (LYs) and quality-adjusted life years (QALYs) gained.  Effectiveness and utilities were obtained from literature. Local costs (expressed in 2011 $US) and epidemiology (data from 2009-2011) were obtained from Panamá´s official databases. Univariate sensitivity analysis was performed. The time horizon for total costs was one year and for outcomes was lifetime with a discount rate of 3%. RESULTS: . Results show that immunization is cost-saving against no-vaccination. PCV-13 gained the highest number of QALYs (305) against PCV-10 (191) and PCV-7 (168). PCV-13 prevented 629 illnesses and gained 334 LYs. PCV-10 and PCV-7 prevented 392 and 359 illnesses and gained 208 and 182 LY´s, respectively. Total costs of illness with PCV-13, PCV-10, PCV-7 and no vaccination were $622,445, $777,878, $804,978 and $1,005,512, respectively. These results were robust to variations in herd immunity and impact adjustments of PCV-10 immunogenicity. CONCLUSIONS: . This is the first cost-effectiveness study for anti-pneumococcal immunization in Panamá. Immunization strategies based on 7, 10 and 13-valent PCV´s may be cost-saving interventions compared to no vaccination. PCV-13 dominates PCV-10 and PCV-7.