OBJECTIVES Vaccination of elderly and at-risk population against Streptococcus pneumonia is recommended and partially reimbursed in Turkey due to the substantial medical and economic burden. However, only ~2% of these populations were vaccinated in 2007. A three-step economic analysis was designed to measure the burden of pneumococcal infections (pneumonia and bacteremia) from a public payer perspective in elderly (>60 years) and at-risk adults (18–59 years), and to evaluate the benefits of implementing a vaccination program. METHODS Firstly, we evaluated the cost of pneumonia and bacteremia in retrospective and prospective studies in public hospital services in Ankara. Secondly, a static model was used to evaluate cost-effectiveness of vaccination in the two targeted populations using demographic and epidemiological data obtained from Turkish sources or, when unavailable, from international literature. A stochastic Monte Carlo simulation estimated the incremental cost-effectiveness ratio in Euros (€) per life year gained (LYG), assuming that vaccination protected for 5 years with 50-70% effectiveness against pneumococcal bacteremia and 15-45% against pneumococcal pneumonia. Finally, the budget-impact associated with the percentage of people vaccinated was analyzed. RESULTS The mean effectiveness of pneumococcal vaccination in the Turkish population was 31,611 LYG (95% CI: 30,756–32,467) in the elderly and 13,353 LYG (95% CI: 12,989–13,716) in at-risk adults. The vaccination program was found to be cost saving with mean incremental savings of €76 million (95% CI: 170 to 122) in the elderly and €35 million (95% CI: 74 to 59) in at risk adults. Budget impact analysis showed that the total cost saved increased with increasing vaccine coverage rate. CONCLUSIONS This analysis suggests that pneumococcal vaccination of elderly and at-risk adults is associated with a positive return on investment from a public payer perspective and supports the continued recommendation of pneumococcal vaccines, as well as their full funding.