OBJECTIVES: Hospital-treated pneumonias (HTP) are associated with substantial individual and societal burden in adults and elderly. Moreover, adults with e.g. vascular, metabolic or respiratory diseases have a 3-6 times higher risk of HTP when compared with their healthy controls. Persons at risk are likely to benefit most from pneumococcal vaccinations. The 13-valent pneumococcal conjugate vaccine (PCV13) has showed to prevent community-acquired pneumonia and invasive pneumococcal disease in adults. The objective of this study was to estimate the expected 5-year health economic impact of targeted PCV13 compared with no vaccination in Finnish home care customers.   METHODS: A budget impact model was developed to predict the impact of PCV13 vaccination in terms of costs and HTP events avoided at the national and municipal level. A dynamic-cohort Markov modelling approach and a time horizon of 5 years was used. The baseline number of home care customers and HTP events were gathered from Finnish national registries. The efficacy of PCV13 was estimated based on CAPITA trial. Only direct costs in 2014 value were considered in the analysis.         RESULTS: All 105,572 Finnish home care customers are considered to be at moderate or high risk for HTP because of underlying chronic medical conditions. Vaccination of these people with PCV13 could provide an undiscounted net budget savings of about €29.2 million compared with the current no-vaccination situation over the next 5 years. Among the risk groups considered, the largest absolute undiscounted net savings (€13.4 million) could be obtained by vaccinating people with heart disease, due to its high prevalence in the target population.   CONCLUSIONS: In Finland, the direct immunization of home care customers with PCV13, is estimated to lead to substantial cost savings in the following 5 years after vaccination.