Paediatric meningitis is a major, life threatening disease resulting in severe, lifetime sequelae. OBJECTIVE: To estimate the lifetime cost to the New Zealand Government of severe disability ensuing from paediatric pneumococcal meningitis. METHODS: 'Severe disability' was defined as 'disability sufficient to preclude enrolment at a mainstream UK school.' The epidemiology of paediatric disability was obtained from a recent UK study of survivors of pneumococcal meningitis, and validated using Auckland data. Long-term costs were estimated from age-specific cross-sectional data obtained from the Ministries of Education, Health and Social Development and 30 provider agencies. Representative healthcare costs were obtained for the following services: home/carer support packages; audiology, hearing devices and cochlear implants for severe or profound bilateral sensorineural hearing loss; assessment and rehabilitation services for cerebral palsy and epilepsy; orthotics services for cerebral palsy; residential facilities; specialised equipment; housing modifications; GP consultations; pharmaceuticals; hospital costs for epilepsy and corrective surgery for physical disabilities. Other costs comprised disability allowances plus income and vocational support. The cost from birth to age 64 years was obtained by multiplication of 3 matrices in 5-year age bands: weighted mean annual costs across all categories of expenditure; survival (from life tables) and an age-specific discounting factor (at 5% discount rate). RESULTS: The Government cost to age 64 of severe disability resulting from pneumococcal meningitis contracted in the first year of life is estimated at $NZ0.88M ($US0.44M) discounted to present value at 5% per annum ($NZ2.8M undiscounted). This cost is sensitive to the distribution of disability by type and severity. The main costs are: individual home and carer support (28%); education (23%); residential care (18%); income support (13%); environmental support (10%); and bilateral severe or profound hearing loss (7%). CONCLUSIONS: Lifetime costs to the Government associated with severe disability resulting from paediatric pneumococcal meningitis are substantial.