OBJECTIVES: Invasive pneumococcal disease (IPD) is a major public health challenge. The elderly is a high risk (HR) population to develop IPD and this risk is raised in the presence of chronic illness. This study aims to perform cost-effectiveness analysis of 13-valent pneumococcal conjugated vaccine (PCV13) in elderly HR, from a public payer perspective in Brazil. METHODS: A Markov model was developed to simulate IPD outcomes in elderly HR after vaccination with PCV13 versus PPSV23 and no vaccination, with regard to associated direct costs in a 10-year time horizon. Effectiveness parameters are avoided cases of IPD, meningitis, pneumonia, and bacteremia. Medical costs included hospital days, medical personnel time, outpatient visits, diagnostic tests and medications. Clinical data and costs were extracted from literature, presented in 2011USD. RESULTS: For an 1,000,000 patients cohort, PCV13 avoided [14,159;14,885] bacteremia, [1,119;1,327] meningitis, [190,831;198,098] hospitalized pneumonia, [153,569;150,599] non-hospitalized pneumonia, and [56,102;58,686] IPD deaths, versus [PPSV23;no vaccination] respectively. Medical and vaccination costs for PCV13 versus PPSV23 and no vaccination were 7,901,973.76 BRL, 8,823,681.28 USD, and 8,327,792.71 USD, respectively. PCV13 was the dominant alternative in this cost-effectiveness analysis. CONCLUSIONS: From the public payer perspective in Brazil, PCV13 showed to be dominant compared to PPSV23 and no vaccination in elderly high risk population.