OBJECTIVES: To evaluate cost–effectiveness of pneumococcal vaccination with 10-valent pneumococcal non-typeable Haemophilus influenzae protein-D conjugate vaccine (PHiD-CV) compared with 13-valent pneumococcal conjugate vaccine (PCV-13) and no vaccination in Kazakhstan. METHODS: A steady state model with a one-year time horizon was developed to project the impact of vaccination on the incidence of pneumococcal and non-typeable Haemophilus influenzae infections in children aged 0-10 years. Disease incidence rates for meningitis, bacteremia, pneumonia and acute otitis media (AOM) were based on data from the Ministry of Health, benchmarked with other countries and validated by a group of local experts. Pneumococcal serotypes distribution is based on 4,752 samples reported by GAVI for Asian region. Serotypes coverage rates of 65.67% and 69.5% for PHiD-CV and PCV-13, payer perspective, 3+1 schedule, no herd protection were assumed. RESULTS: PHiD-CV and PCV-13 are projected to prevent more cases of invasive disease (278; 294 respectively), and pneumonia hospitalizations (12270; 12270 respectively) compared to no vaccination. PHiD-CV and PCV-13 are projected to prevent additional myringotomies (1920; 949 respectively) and GP visits due to AOM (70,057; 34,639 respectively) compared to no vaccination strategy. No difference in absolute number of death was projected when PHiD-CV is compared with PCV-13. Vaccinating a birth cohort with PHiD-CV or PCV-13 is expected to generate 4,541 and 4,388, respectively, more QALYs compared to no vaccination. At vaccine steady state PHiD-CV is projected to generate USD 1.27 million in direct medical cost-savings compared with PCV-13. Sensitivity analyses indicate that incidence rate of meningitis and bacteremia are the most sensitive parameters in the model. CONCLUSIONS: Pneumococcal conjugate vaccines would be cost effective interventions for Kazakhstan. However, PHiD-CV dominates PCV-13 because it has a larger potential QALY gain and higher cost offset related to the additional benefits due to AOM reduction.