OBJECTIVES: Pneumococcal disease causes serious morbidity and mortality in the elderly. To understand the value of pneumococcal vaccination in the elderly, we modeled the cost-effectiveness of a one dose pneumococcal vaccination schedule for the elderly in South Korea. METHODS: We identified hospitalizations for pneumococcal disease in the Korean national health insurance database for January to December 2005. Patients were identified with non-bacteremic pneumococcal pneumonia (NBPP) and bacteremic pneumococcal pneumonia (BPP) using a standardized list of International Classification of Diseases, 10th revision (ICD-10) diagnostic codes. Epidemiologic (e.g., incidence and mortality rates) and economic variables (e.g., direct medical costs) were used to model the cost-effectiveness ratios in a hypothetical elderly cohort aged ≥ 65 years.RESULTS: In 2005, there were 4,365,218 persons aged ≥ 65 years in South Korea. Based on the national hospitalization data, the incidence of NBPP was 1,350/100,000 ≥ 65 years and the incidence of BPP was 3.4/100,000 ≥ 65 years. Our base case estimate shows that pneumococcal disease in the elderly, in the absence of pneumococcal vaccination costs (US$131,366,412) annually. Our model suggests that 16,856 NBPP and 300 BPP hospitalizations each year may be averted routine pneumococcal vaccination in the elderly. In addition, our model shows that 4225 lives (95% CI; 4014 to 4435) will be saved each year in a routine program of pneumococcal vaccination for adults aged ≥ 65 years. In this preliminary analysis, we found an incremental cost-effectiveness ratio of US$5774 per life year gained.CONCLUSIONS: In South Korea, routine pneumococcal vaccination for the elderly is likely to result in a substantial reduction of both serious morbidity and mortality. Additional data inputs for our model will be obtained in order to refine our estimates of the cost-effectiveness of adult pneumococcal vaccination in South Korea.