Background:Immunization decision-making (IDM) should draw on high quality evidence from various sources such as health economics (HE). Objective of this study was to test the applicability of a framework that enables a systematic, transparent, and evidence based IDM based on multiple criteria. Method: We applied the ‘Evidence to Decision (EtD) Framework’ developed by the ‘Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence’ (DECIDE) collaboration to the example of vaccination against pneumococcal-disease (PD) in adults and utilized HE evidence from a modeling study for Germany. We tested how EtD criteria can be operationalized for the development of a specific IDM on which HE was expected to have a strong impact. A panel of members of the Methods-Working-Group of the German standing committee on vaccination (STIKO) was asked to use the EtD framework and judge on its applicability and usefulness for IDM. Results:Data from the HE model were used to inform one out of six criteria (disease-burden, evidence quality, magnitude of effects, balance of effects, cost-effectiveness, acceptability) of the EtD framework. Since two vaccine-types (23-valent polysaccharide and 13-valent conjugate vaccine [PPSV23, PCV13]) were compared in the HE model, judgement options for the HE criterion were: ‘favors PPSV23’; ‘favors PCV13’; ‘favors sequential vaccination PCV13&PPSV23’; ‘does not favor either’; ‘favors no vaccination’. Panel-members reported the usefulness of the EtD framework for IDM on PD vaccination, especially regarding the integration of HE result-figures. Discussion:The EtD framework seems very suitable to consider HE in evidence based IDM even in a complex situation where multiple vaccination strategies are compared. It’s in particular helpful to communicate HE results-figures to non-economists and supports transparency in IDM. In the project ‘Standardization of healTh Economic Evaluations of vaccINes in Germany’ (STEErING) the integration of HE in IDM will be further explored.