OBJECTIVES: Until recently two conjugated pneumococcal vaccines were available, PCV7 and PCV10. This study evaluated the efficacy, safety and cost-effectiveness of 13-valent pneumococcal vaccine (PCV13), a vaccine licensed in 2010 for the prevention against Streptococcus pneumoniae infections, as a first step in the evaluation of possible incorporation into health systems.   METHODS: Medline, The Cochrane Library, Lilacs and the Centre for Reviews Dissemination were searched for systematic reviews (SR) with meta-analysis evaluating the efficacy and safety of PCV13 in the prevention of pneumococcal disease in children, and for pharmacoeconomic studies evaluating the use of PCV13 compared to PCV10 and/or PCV7. The quality of evidence was assessed using the modified GRADE system.  RESULTS: We included one SR with meta-analysis comparing PCV7 to PCV13, and 11 pharmacoeconomic studies, including ten cost-effectiveness analyses of PCV7, PCV10 and PCV13. The SR, of moderate quality, demonstrated similar safety profile between therapeutic alternatives and superior efficacy of PCV13. The pharmacoeconomic studies showed different results of cost-effectiveness: PCV10 was dominated in four (Argentina; Japan; Colombia; and Sweden in a study sponsored by GSK); PCV13 in three (Germany and Greece; Mexico; Singapore); and no preference in three (Holland; Australia; and Denmark and Sweden in a study sponsored by Pfizer). Neither PCV10 nor PCV13 was cost-effective in Thailand (cost-utility analysis).  CONCLUSIONS: In general, PCV13 and PCV10 presented similar safety and efficacy profiles. PCV13 provides protection for three additional serotypes associated with pneumonia, however these are not commonly found in the community. PCV10, on the other hand, provides better result for otitis.  Individual countries should take this into account when assessing incorporation. Also, economic studies show that the cost of the technology is the main factor to be considered, indicating that PCV13 will have a favorable ratio only if the cost of the vaccination schedule is equivalent or lower than PCV10.