OBJECTIVES: . Despite the Ecuadorian policy of vaccination for high risk persons and adults over 50 years age with 23-valent pneumococcal polysaccharide vaccine (PPSV23), Streptococcus pneumonia infections continue to be the most common disease, causing approximately 3,158 deaths every year and raising public health costs. A 13 valent pneumococcal conjugate vaccine (PCV13) has recently been approved for use in adults, and is expected to have an additional impact on disease burden due to covered serotypes. The purpose of this study was to compare PPSV23 and PCV13 vaccines from an Ecuadorian public perspective. METHODS: . A cost-effectiveness analysis based on a Markov model was developed comparing the impact and cost-effectiveness of PPSV23 and PCV13 for the prevention of pneumococcal disease in high risk adult population. Time horizon of the model was 35 years, with annual discounting of 5% per annum. The effectiveness measure was the number of cases avoided and cost differences between the interventions. Resource use and costs were obtained from Ministry of Health published data, INEC, and SIREVA reports. Costs were collected from local healthcare databases. RESULTS: . The model reveals that PCV13 is a cost-saving alternative compared to PPSV23. Vaccination with PCV13 is estimated to prevent an additional 1443 cases of bacteremia; 162 cases of meningitis; 11,236 cases of inpatient pneumonia; 1,241 cases of outpatient pneumonia and 3413 deaths due disease compared to PPSV23. Furthermore, vaccination with PCV13 is estimated to save thousands: 25,329 USD in medical costs, 3,874 USD in non medical costs and 46.027 USD in medical+ non medical+vaccination costs. CONCLUSIONS: In Ecuador, a national policy of vaccination with PCV13 is expected to be a cost-saving strategy in the prevention of pneumococcal disease in high risk patients and adults over 50 years compared to PPSV23.  PPV13 is expected to generate reduction on mortality and morbidity with lower expected costs