OBJECTIVES: Vaccination is an effective method to reduce mortality and morbidity from pneumococcal disease.   Three pneumococcal conjugate vaccines (PCVs) are currently available with varying serotype coverage (PCV-7, PCV-10, and PCV-13), therefore it is necessary to carefully evaluate and compare their potential public health and economic impacts before implementation. This study aims to estimate the cost-effectiveness of immunization strategies based on the PCVs currently available on the Ecuadorian market from a societal perspective. METHODS: A decision tree model was implemented to estimate the public health and economic impact of PCV use in a cohort of children younger than two years of age (lifetime horizon, discount rate: 3% annual).  Alternatives strategies included: no vaccination (reference case) versus 7, 10, and 13 valent PCV´s. The measures of effectiveness considered were: deaths avoided, life years gained (LYG) and quality adjusted life years (QALY´s) gained. Effectiveness, utility, local epidemiology and cost of treating pneumococcal diseases were extracted from published sources and gray literature. RESULTS: All three immunization alternatives dominate the no vaccination scenario. Compared to no vaccination, PCV-13 is estimated to prevent 986 deaths, saving 29,410 LY´s and 26,852 QALY´s.  This strategy represented cost savings of $550 per vaccinated child.  The other two vaccination alternatives, PCV-7 and PCV-10, prevented 537 and 940 deaths; saved 15,865 and 28,129 LY´s; saved 14,584 and 25,662 QALY´s; and saved $255 and $527 per vaccinated child, respectively. These results are robust to variations in herd immunity, but sensitive to the prices of the vaccine per dose and the number of doses. CONCLUSIONS: In Ecuador, immunization strategies based on PCV 7, 10, and 13 valent vaccines would be cost saving interventions compared to no vaccination.  The PCV-13 valent strategy dominates in terms of cost-effectiveness and cost-utility to PCV 7 and PCV10.