OBJECTIVES::  To 1) assess the cost-effectiveness of vaccinating adults aged 60 years with PPV23 compared to no vaccination, 2) vaccinating with PCV13 at age 60 years, or 3) sequential vaccinating with PCV13 at 60 years followed by PPV23 within 6-12 months in Brazil. METHODS::  A population-based Markov model was developed. The model has five health states including no pneumococcal disease, invasive pneumococcal disease (IPD), non-bacteremic pneumococcal pneumonia (NBPP), post-meningitis sequelae and death. A cohort of 60-year-olds in Brazil was followed up to 100 years of age or until death. Vaccine efficacy against IPD was obtained from a meta-analysis and a clinical trial. Vaccine efficacy against NBPP was obtained from a population-based cohort study and a clinical trial. Vaccination coverage of 80% was assumed. Cost and utility were discounted at a rate of 5% annually. Incremental cost-effectiveness ratio (ICER) expressed as additional cost per quality-adjusted life year (QALY) gained was estimated as the main outcome. The World Health Organization definition of less than 3 times per capita Gross Domestic Product in Brazil (i.e., US$25,616/QALY) was used as the threshold of cost-effectiveness. Sensitivity analyses were conducted to test the robustness of the result. RESULTS::  In the base case analysis, compared to no vaccination, discounted incremental costs and incremental QALYs gained for PPV23 were estimated at $12.04 million and 3,860, respectively, corresponding to an ICER of $3,116/QALY. Compared to PCV13, vaccinating with PPV23 was associated with a reduction of cost by $12.41 million and an increase in QALYs by 1,400. The sequential strategy was estimated to have incremental cost of $25.23 million and incremental QALYs gained of 370 compared to PPV23, however it was deemed to be not cost-effective at an ICER of $68,969. CONCLUSIONS:: Vaccinating adults aged 60 years with PPV23 was estimated to be a cost-effective vaccination strategy in Brazil.