OBJECTIVES Like other North African countries, Tunisia has a substantial burden of pneumococcal disease, with high resistance to antibiotics. The Tunisian population remains largely unprotected in the absence of a national immunization program (NIP). METHODS A decision-analytic model was developed to evaluate the potential outcomes and costs of the PCV13-based NIP compared to no vaccination. The model estimates bacteremia and meningitis (jointly IPD), all-cause community acquired pneumonia (CAP), and all-cause otitis media (OM). The demographics and disease characteristics were obtained from WHO estimates or local sources, adjusted to local conditions. PCV13 direct and indirect effectiveness was extrapolated from PCV7 trials and surveillance records, adjusted to local serotype distribution. Cost of vaccine was USD 16.34. A discount rate for cost and life-years was 3%. The payer and societal perspectives were considered.  RESULTS The budget impact in a single year with PCV13-based NIP in place would amount to USD 1.82 million, or USD 7.93 million without indirect vaccine protection considered. From this investment, 141 971 illnesses (1071 IPDs, 12477 CAPs and 128423 OMs) and 347 deaths could be avoided annually. Without indirect vaccine protection, 58 524 illnesses (601 IPD, 4721 CAP, 53202 OM) and 184 deaths could be avoided. The cost-effectiveness analysis produced ICER of USD 340/LYG or USD 367/QALY from the payer’s perspective. From the societal perspective, the NIP is dominant. Not considering indirect protection, the ICER would be USD 140/LYG or USD 152/QALY from a societal perspective and USD 1157/LYG or USD 1254/QALY from a payer perspective. CONCLUSIONS PCV13-based NIP delivers benefits and cost savings that greatly offset the investment into vaccine. WHO strongly encourages investment in interventions that deliver an additional year of life in full quality for less than one GDP per capita (USD 4237); hence, a PCV13-based NIP with the above ICER presents an attractive option.