OBJECTIVES: To evaluate the cost effectiveness of vaccinating the Brazilian state of São Paulo’s population 60 years of age and older with the 13-valent pneumococcal conjugate vaccine (PCV13) in comparison to the 23-valent pneumococcal polysaccharide vaccine (PPV23), each as a single dose, from the public payer perspective.  METHODS: In order to estimate the pneumococcal disease costs and impact over a 40-year time horizon period, including acute meningitis (AM), invasive pneumococcal disease (IPD), hospitalized pneumonia (HP) and non-complicated pneumonia (NCP), a patient-level microsimulation model simulating vaccination and outcomes of one cohort of 4.768.202 individuals 60 years of age and older was adapted. The probabilities and direct medical costs were extracted from literature review and national databases, with costs presented in US$2011. The effectiveness measures were expressed as cases of pneumococcal diseases avoided, overall deaths avoided, and life years (LYs) saved. Effectiveness of PCV13 was derived from studies in children and adjusted for age and immune status in the elderly; PPV23 was assumed not to impact pneumonia based on published meta-analyses. Probabilistic sensitivity analyses were conducted considering key variables. Discount rate of 5% was applied.  RESULTS: Vaccinating with PCV13 prevents 281 AM, 3.615 IPD, 56.284 HP, 31.553 NCP and 15.742 deaths, saving 90.596 LYs compared to PPV23. Total costs including vaccination and medical costs resulted in US$14.449.125 less for PCV13 compared to PCV23 (US$786.747.906 vs. US$772.298.781). The model showed robustness through sensitivity analyses. CONCLUSIONS: The analysis suggests that vaccinating adults with PCV13 in Brazil is cost-saving compared to PPV23. The results in economic and disease burden are substantial and they support the decision making in favor of PCV13 for its high impact in public health.