OBJECTIVES: To evaluate the clinical and economic benefits of routine infant vaccination with the 7-valent pneumococcal conjugate vaccine (Prevenar, PCV7) in Hong Kong, Singapore and Taiwan. METHODS: National databases and hospital case records were used to calculate the local age-specific disease burden of both invasive (bacteremia and meningitis) and non-invasive (pneumonia and otitis media) pneumococcal presentations in each country. A decision-analytic model was subsequently populated with this data to simulate the expected health outcomes resulting from universal PCV7 vaccination of each birth cohort over a ten-year horizon. Base case analyses were conducted from a payer perspective using local direct cost parameters associated with the treatment of pneumococcal disease. The indirect effect of routine infant vaccination on unvaccinated populations was also considered by calculating the reduction in adult IPD cases and associated cost avoidance due to indirect (herd) protection, in line with published overseas rates.RESULTS: There was considerable variability in the data available for analysis in each country. Over a 10-year period, routine PCV7 infant vaccination led to a substantial reduction in the incidence of invasive and non-invasive pneumococcal disease in both children and adults for each country-specific evaluation. The prevention of these cases resulted in significant savings in healthcare expenditure associated with treating pneumococcal disease. Across the three analyses, a routine infant PCV7 program was estimated to have an incremental cost per life year gained of US$5,718 – US$19,713 from a payer perspective.  CONCLUSIONS: For each analysis, routine infant PCV7 vaccination was shown to have a significant impact on reducing the incidence of IPD across the total population. The cost savings from the indirect protection of the adult populations in each country led to PCV7 vaccination being very cost-effective, and within the World Health Organization threshold for cost-effectiveness. These analyses will be useful to inform vaccine policy in these countries.