OBJECTIVES: :  The Pneumococcal disease is a major cause of morbidity and mortality in pediatrics, and it leads to serious health as well as economic burden on the national health care system. In Korea, both 13-valent and 10-valent pneumococcal conjugate vaccines are currently used for the prevention of pneumococcal infections for Pediatrics. This study aims to evaluate the long-term economic and clinical impact of PCV-13 versus PCV-10 vaccination in prevention of IPD, pneumonia and acute otitis media (AOM) from health care system perspective. METHODS: :A Markov cohort model with a 10-year time horizon was used to estimate the effect of infant vaccination with PCV-13 versus PCV-10. Using this model, we considered disease incidence and serotype coverage and health care utilization to compare costs and clinical impact of PCV-13 versus PCV-10 on IPD, inpatient and outpatient pneumonia, and AOM , among vaccinated children (direct effect) and the entire population with indirect(herd effects). Patients were entered in the model by age groups: ages 0-<2 years, 2-4 years, 5-17 years, 18-34 years, 35-49 years, 50-64 years, 65+ years. Only 0-2 year cohort was vaccinated. The local epidemiology and cost data were used to achieve national specificity. Direct/Indirect effectiveness of PCV-13 and PCV-10 were calculated based on PCV-7 efficacy data, using assumptions regarding serotype coverage and PCV-10 and PCV-13 protection against additional serotypes. RESULTS: : In the analysis, PCV-13 vaccination has caused significant decline in all PD cases. It was estimated to prevent 19,918 cases of IPD, 3,796,657 cases of pneumonia, and 53,310,807 cases of AOM in 10-year cohort. Also the incremental cost per LYG was estimated at 10,043,048 won for the PCV-13 vaccination from the health care system perspective in the 10-year horizon, as compared to PCV-10 vaccination. CONCLUSIONS: : PCV-13 vaccination program provided economic and clinical impact on overall PD prevention and cost-effective compared with PCV-10 vaccination.