OBJECTIVES: Information of cost-effectiveness analysis has been used for vaccine policy making. Especially, in the US, guideline for pneumococcal vaccines in adults 65 years or older has recently revised by recommendation of the Advisory Committee on Immunization Practices (ACIP). We would review the process to find critical issues influencing vaccine policy decisions in Japan. METHODS: Systematic literatures were performed to find critical comments on the ACIP decisions. Reference databases (PubMed and Science Direct) were used to find related topics between May 25, 2014 to Nov 25, 2015. Main issues were extracted from review papers and letters/comments to authors. A Markov model to compare two pneumococcal vaccines (PPSV23 and PCV13) was used for sensitive analyses to evaluate how each issue would influence the cost-effectiveness findings. RESULTS: We identified 11 critical comments by the literature reviews. Among them, the sensitivity analyses identified the following three factors that highly influenced the findings: (1) incidence rate of invasive pneumococcal disease (IPD), (2) held effects from children to elderly, and (3) vaccine effects on healthcare associated pneumonia (HCAP). A sequential vaccination program including PCV13 was found to be cost-effectiveness strategy in Japan similar to the ACIP decision. CONCLUSIONS: The finding suggested that precise information would be required on IPD incidence, herd immunity and HCAP burden for conducting cost-effectiveness analyses in Japan. We would modify the model to reflect healthcare environment in Japan and accommodate additional information collecting through clinical and epidemiology studies for PPSV23 and PCV13 for Japanese elderly population.